CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Radiation Oncology, General Surgery, Plastic Surgery·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Jul 11, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (Georgia) now requires prior authorization through Carelon Medical Benefits Management for two intraoperative radiation therapy (IORT) codes used in breast cancer treatment: CPT 19294 (tumor cavity preparation with IORT applicator) and CPT 19297 (radiotherapy catheter placement for interstitial radiation). All ordering and servicing providers must obtain precertification before these procedures are performed.
Action Required
By November 1, 2026: Billing team and providers must implement prior authorization requirement for CPT 19294 and CPT 19297 in the billing system and clinical workflows. (1) Update billing software to flag these codes as requiring prior authorization for Anthem Blue Cross and Blue Shield Georgia commercial plans. (2) Brief surgical team and radiation oncology staff that all partial mastectomy cases with intraoperative radiation must have precertification submitted to Carelon Medical Benefits Management BEFORE the procedure date. (3) Establish internal protocol: designate staff member to submit authorization requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) at least 5-7 business days before scheduled procedure. (4) Add reminder prompts to encounter forms and surgical schedules. Failure to obtain prior authorization will result in claim denial and potential patient responsibility. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com with questions (UM AROW #A2026M5988).