Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·CA · Genetics, Oncology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
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.
Action Required
By October 31, 2026: Billing team must update billing system to flag CPT code 81345 for mandatory prior authorization submission to Carelon Medical Benefits Management before claims are submitted. Providers and ordering physicians must be notified that genetic testing for TERT analysis now requires precertification. Update encounter forms and order entry workflows to include a reminder for prior auth request. Submit all authorization requests via Carelon's provider portal at https://providerportal.com or through Availity Essentials at https://Availity.com. For questions on authorization guidelines, contact MedicalBenefitsManagement.guidelines@Carelon.com. Claims submitted without prior authorization will be denied for Anthem Blue Cross Medicare Advantage members in California.