Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Oncology, Neurology, Genetics·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 2, 2026
Summary
Effective November 1, 2026, CPT code 81345 (TERT gene analysis for thyroid carcinoma and glioblastoma multiforme) now requires prior authorization/precertification through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing this genetic test.
Action Required
By October 15, 2026: Billing team and ordering providers must implement prior authorization requirement for CPT 81345 in all billing and ordering workflows. (1) Update billing system to flag CPT 81345 for Anthem Medicare Advantage Georgia members and require prior auth before claims submission. (2) Configure encounter forms and ordering templates to alert providers that CPT 81345 requires precertification. (3) Train providers and staff to submit authorization requests via Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) for all TERT gene analysis orders. (4) Create internal checklist for genetic testing coordinators. Claims submitted without prior authorization will be denied by Carelon Medical Benefits Management.