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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Genetics, OncologyMedium impact

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Oct 31, 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 precertification/prior authorization through Carelon Medical Benefits Management for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers must obtain authorization before ordering this genetic test.

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What to do

by Oct 31, 2026 · 6 steps
01Billing team must update billing system to flag CPT code 81345 for mandatory prior authorization submission to Carelon Medical Benefits Management before claims are submitted.
02Providers and ordering physicians must be notified that genetic testing for TERT analysis now requires precertification.
03Update encounter forms and order entry workflows to include a reminder for prior auth request.
04Submit all authorization requests via Carelon's provider portal at https://providerportal.com or through Availity Essentials at https://Availity.com.
05For questions on authorization guidelines, contact MedicalBenefitsManagement.guidelines@Carelon.com.
06Claims submitted without prior authorization will be denied for Anthem Blue Cross Medicare Advantage members in California.

Codes mentioned

81345

Original notice

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[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[Virginia] 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

Related policy hubs

Anthem BCBS policiesCA policy changesGeneticsOncologyCode 81345

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