Medicare AdvantagePrior AuthHigh impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab) +3 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 8, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Virginia will require precertification/prior authorization through Carelon Medical Benefits Management for 13 specific DMEPOS codes covering lumbar-sacral orthoses, knee orthoses, ankle-foot orthoses, and the Flex Foot System. Ordering and servicing providers must submit authorization requests via Carelon's provider portal or Availity before dispensing these devices.
Action Required
By October 31, 2026: Billing team and DME suppliers must update billing workflows and systems to require prior authorization for HCPCS codes L0631, L0637, L0639, L0648, L0650, L0651, L1832, L1843, L1844, L1845, L1846, L1851, L1852, L1932, L1951, and L5980 on all Anthem Medicare Advantage claims in Virginia. Providers and staff must be trained to submit precertification requests to Carelon Medical Benefits Management via the provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) BEFORE dispensing orthotic devices. Add alerts to encounter templates and billing software to flag these codes for authorization verification. Failure to obtain prior authorization will result in claim denials for these DMEPOS items.