CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·OH · 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 Anthem Blue Cross and Blue Shield commercial plans in Ohio. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing this procedure.
Action Required
Before November 1, 2026: Cardiology providers and billing staff must update internal workflows to require prior authorization for CPT 93146. (1) Providers: Update order entry systems and clinical protocols to flag CPT 93146 as requiring Carelon precertification. (2) Billing team: Configure billing software to not process claims for CPT 93146 without prior authorization documentation. (3) All staff: Register with Carelon's provider portal at https://providerportal.com or use Availity Essentials at https://Availity.com to submit authorization requests in real-time. For guideline questions, contact MedicalBenefitsManagement.guidelines@Carelon.com. Failure to obtain prior authorization will result in claim denials for Anthem Blue Cross and Blue Shield commercial members in Ohio.