CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·VA · Cardiology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 8, 2026
Summary
Effective November 1, 2026, CPT code 93146 (carotid sinus baroreflex activation therapy device interrogation) now requires precertification/prior authorization through Carelon Medical Benefits Management for all Anthem Blue Cross and HealthKeepers PPO and HMO plans in Virginia. Billing teams must submit authorization requests before performing this procedure to avoid claim denials.
Action Required
By October 15, 2026: Billing team and cardiology providers must update internal workflows to require prior authorization for CPT 93146. (1) Update billing system rules to flag CPT 93146 for Anthem/HealthKeepers Virginia patients and require Carelon prior auth before claim submission. (2) Instruct cardiology providers to submit precertification requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before scheduling or performing the procedure. (3) Add CPT 93146 to encounter forms with a reminder to obtain prior authorization. (4) Train front desk and scheduling staff to confirm prior auth is in place before appointments. For guideline questions, contact MedicalBenefitsManagement.guidelines@Carelon.com. Failure to obtain prior authorization will result in claim denials.