CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·VA · Urology, Bariatric Surgery, Neurosurgery·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 3, 2026
Summary
Effective November 1, 2026, Carelon Medical Benefits Management now requires precertification/prior authorization for four specific procedure codes related to bladder dysfunction neurostimulation and bariatric surgery for all Anthem BCBS and HealthKeepers commercial PPO and HMO plans in Virginia. Billing teams must obtain prior authorization before submitting claims for CPT codes 0988T, 0989T, 43889, and HCPCS code C1607.
Action Required
Before November 1, 2026: Billing team must update authorization workflows to require prior authorization for CPT codes 0988T, 0989T, 43889, and HCPCS code C1607 for all Virginia Anthem BCBS and HealthKeepers commercial (PPO and HMO) plans. Register with Carelon Medical Benefits Management provider portal at https://providerportal.com or via Availity Essentials at https://Availity.com to submit precertification requests. Update encounter forms, superbills, and billing system rules to flag these codes as requiring prior auth before claim submission. Ensure ordering and servicing providers are notified of the new requirement. Claims submitted without prior authorization will be subject to denial. Direct guideline questions to MedicalBenefitsManagement.guidelines@Carelon.com.