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[New York] 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 in New York will require prior authorization through Carelon Medical Benefits Management for two intraoperative radiation therapy codes (CPT 19294 and 19297) used in breast cancer treatment. Billing teams must update workflows to obtain precertification before submitting claims for these procedures.
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What to do
by Nov 15, 2026 · 7 steps
01Billing team and providers must implement prior authorization requirement for CPT 19294 and CPT 19297.
02Update billing system to flag these codes as requiring precertification before claim submission.
03Providers and clinical staff must submit authorization requests to Carelon Medical Benefits Management via their provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) BEFORE surgery is scheduled or performed.
04Update encounter forms and pre-operative checklists to remind ordering providers.
05Communicate with radiation oncology and surgical teams that these procedures cannot proceed without documented prior authorization.
06Failure to obtain prior auth will result in claim denials.
07For guideline questions, contact MedicalBenefitsManagement.guidelines@Carelon.com.
Codes mentioned
1929419297
Original notice
[New York] 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 →[Ohio] 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[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Feb 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list