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[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
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.
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What to do
by Oct 15, 2026 · 6 steps
01Billing team and ordering providers must implement prior authorization requirement for CPT 81345 in all billing and ordering workflows.
02Update billing system to flag CPT 81345 for Anthem Medicare Advantage Georgia members and require prior auth before claims submission.
03Configure encounter forms and ordering templates to alert providers that CPT 81345 requires precertification.
04Train 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.
05Create internal checklist for genetic testing coordinators.
06Claims submitted without prior authorization will be denied by Carelon Medical Benefits Management.
Codes mentioned
81345
Original notice
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
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