Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Genetics, Oncology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
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.
Action Required
Before 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. Update billing system to flag CPT 81345 for mandatory prior auth submission to Carelon Medical Benefits Management before service delivery. Establish workflow to submit requests via Carelon provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com). Notify ordering providers and genetics counselors of the requirement. Claims submitted without prior authorization will be subject to denial.