Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Wound Care, Infectious Disease, General Surgery·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 15, 2026
Summary
Effective November 1, 2026, CPT code 0600U (FidaLab Molecular Wound Infection Test) will require precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage members in Georgia. Providers must submit authorization requests before services are rendered to avoid claim denials.
Action Required
By October 15, 2026: Billing team must update billing system to flag CPT code 0600U for mandatory prior authorization requests through Carelon Medical Benefits Management. Providers and lab staff must be notified that this genetic/molecular test now requires precertification. All authorization requests should be submitted via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before ordering or servicing. Failure to obtain prior authorization will result in claim denials. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions.