Medicare AdvantagePrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · 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) now requires precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage members in New York. Ordering and servicing providers must submit authorization requests via Carelon's provider portal, Availity Essentials, or email before performing this genetic/molecular test.
Action Required
Before November 1, 2026: Billing team must implement prior authorization requirement for CPT code 0600U in the billing system for all Anthem Blue Cross and Blue Shield Medicare Advantage claims originating from New York. Providers ordering this test must obtain precertification via Carelon Medical Benefits Management's provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or by emailing MedicalBenefitsManagement.guidelines@Carelon.com before the service date. Update encounter templates and provider communication to reflect this requirement. Claims submitted without prior authorization will be denied. Establish internal workflow to track authorization status for all 0600U orders.