CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Infectious Disease, General Surgery, Wound Care·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 1, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (Ohio) is adding CPT code 0600U (infectious disease wound infection testing) to the list of codes requiring precertification/prior authorization through Carelon Medical Benefits Management. Providers must obtain prior authorization before performing this genetic/molecular testing or face potential claim denials.
Action Required
Before November 1, 2026: Billing team must update billing software and encounter forms to flag CPT code 0600U as requiring prior authorization for Anthem Blue Cross and Blue Shield Ohio commercial plans. Providers and clinical staff must submit precertification requests to Carelon Medical Benefits Management via the provider portal at https://providerportal.com or through Availity Essentials at https://Availity.com before performing this test. Claims submitted without prior authorization will be subject to denial. Update internal protocols and provider communication to ensure ordering providers are aware of this new requirement.