Medicare AdvantagePrior AuthMedium impact
Special Alert January 2026 - Carelon Radiotracer Management for PET Imaging
Providence Health Plan·Nuclear Medicine, Radiation Oncology, Oncology +1 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jul 2, 2026
Summary
Effective April 1, 2026, Carelon will require both PET and radiotracer CPT codes to be submitted together during the authorization process for Brain PET and Oncologic PET procedures. Approved authorizations will specify which radiotracer categories are allowed based on clinical guidelines. This change affects the prior authorization workflow and claims submission process for PET imaging services.
Action Required
By March 15, 2026: Billing and authorization teams must update prior authorization request workflows to require submission of BOTH PET CPT codes AND radiotracer CPT codes together for Brain PET and Oncologic PET procedures (Cardiac PET excluded). Update encounter forms and billing software system rules to enforce dual-code submission at intake. Train providers and front-desk staff on the new dual-code submission requirement. Beginning April 1, 2026: When submitting prior authorization requests to Carelon for Providence members, always submit PET and radiotracer codes together and reference the approved radiotracer category in the authorization response. Failure to submit both codes together may result in authorization delays or claim denials. Contact Carelon MBM at (800)-252-2021 for clarification on radiotracer category assignments.