CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·NY · Cardiology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 9, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (through Carelon Medical Benefits Management) is adding CPT code 93146 (carotid sinus baroreflex activation therapy device interrogation) to the list of cardiology procedures requiring precertification/prior authorization in New York. Billing teams must begin routing this procedure through Carelon's portal or Availity before scheduling or billing.
Action Required
By October 15, 2026: Billing and clinical teams must update internal workflows and billing software to require prior authorization for CPT 93146 (carotid sinus baroreflex activation therapy device interrogation) for all Anthem Blue Cross and Blue Shield commercial patients in New York. Providers must submit precertification requests through Carelon Medical Benefits Management via the provider portal at https://providerportal.com (preferred—24/7 access) or through Availity Essentials at https://Availity.com before performing the procedure. Update cardiology encounter templates to include a reminder for providers to obtain prior authorization. Failure to obtain authorization before service delivery will result in claim denials. Contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com for clinical guideline questions.