MedicaidPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Infectious Disease, Wound Care, General Surgery·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 15, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield Medicaid in Ohio is adding a new prior authorization requirement for CPT code 0600U (infectious disease wound infection testing with organism and antibiotic resistance identification). All claims for this test must be precertified before submission to avoid denial.
Action Required
By October 31, 2026: Billing team must update billing system workflows to require prior authorization for CPT 0600U for all Anthem Ohio Medicaid Managed Care members. Add CPT 0600U to the precertification checklist in the EMR and encounter forms. Providers must obtain precertification via Availity Essentials (https://Availity.com), fax (877-643-0672), or phone (800-601-9935) before ordering or billing this test. Flag all claims for CPT 0600U submitted without prior authorization documentation for manual review. Communicate change to all laboratory and wound care staff who may order this test. Failure to obtain prior authorization will result in claim denials.