← Back to list
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective date
Nov 1, 2026
Identified
Jul 2, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Virginia will require prior authorization/precertification through Carelon Medical Benefits Management for CPT 81345 (TERT gene analysis). Ordering and servicing providers must submit authorization requests via Carelon's provider portal, Availity Essentials, or direct contact before performing this genetic test.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
Action · 5 steps
01Before November 1, 2026: Billing team and providers must implement prior authorization requirement for CPT 81345 (TERT gene analysis) for all Anthem Medicare Advantage members in Virginia.
02Update billing system to flag CPT 81345 for mandatory prior auth submission to Carelon Medical Benefits Management before service delivery.
03Establish workflow to submit requests via Carelon provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com).
04Notify ordering providers and genetics counselors of the requirement.
05Claims submitted without prior authorization will be subject to denial.
Codes mentioned
81345
Original notice
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list