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[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Act
by Nov 15, 2026
Effective date
Dec 1, 2026
Identified
Jul 11, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (Ohio) now requires precertification/prior authorization for two intraoperative radiation therapy CPT codes (19294 and 19297) used in breast cancer treatment. All requests for these codes must be submitted through Carelon Medical Benefits Management via their provider portal, Availity Essentials, or email before services are rendered.
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What to do
by Nov 15, 2026 · 5 steps
01Billing team must update the billing system to require prior authorization for CPT codes 19294 and 19297 for all Anthem Blue Cross and Blue Shield (Ohio) commercial claims.
02Providers and surgical coordinators must be notified to submit precertification requests to Carelon Medical Benefits Management through the provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com) BEFORE scheduling or performing these intraoperative radiation therapy procedures.
03Update clinical workflows and encounter forms to include prior authorization checkpoints for partial mastectomy cases involving radiation therapy.
04Claims submitted without prior authorization will be subject to denial.
05Reference UM AROW #A2026M5988 when contacting Carelon for authorization questions.
Codes mentioned
1929419297
Original notice
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Dec 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Dec 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Dec 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementLowEffective Feb 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list