Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Infectious Disease, Wound Care, 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) now requires precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Virginia. Providers must submit authorization requests before performing this genetic/molecular testing to avoid claim denials.
Action Required
By October 31, 2026: Billing team and providers must implement prior authorization workflow for CPT 0600U (FidaLab Molecular Wound Infection Test) for all Anthem Blue Cross and Blue Shield Medicare Advantage patients in Virginia. Update billing system to flag 0600U claims as requiring precertification before submission. Providers must submit authorization requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before ordering the test. Add 0600U to encounter templates and pre-service authorization checklists. Claims submitted without prior authorization will be denied. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions.