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[Ohio] 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, Anthem Blue Cross and Blue Shield Medicare Advantage in Ohio will require precertification/prior authorization for CPT code 81345 (TERT gene analysis for thyroid carcinoma and glioblastoma multiforme) through Carelon Medical Benefits Management. Providers must submit authorization requests before performing this genetic test or claims will be denied.
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What to do
by Oct 15, 2026 · 5 steps
01Billing team and providers must update workflows to require prior authorization for CPT 81345 genetic testing.
02Update billing system rules to flag CPT 81345 as requiring precertification for Anthem Medicare Advantage Ohio members.
03Educate ordering providers that CPT 81345 now requires prior authorization—requests must be submitted to Carelon Medical Benefits Management via provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com).
04Add CPT 81345 to encounter forms and pre-visit planning checklists for oncology/neurology practices.
05Implement verification step: front desk or billing staff must confirm prior authorization approval before specimen collection.
If missed: Failure to obtain precertification will result in claim denial for this genetic test.
Codes mentioned
81345
Original notice
[Ohio] 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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