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[New York] Prior authorization requirement updates — Carelon Medical Benefits Management
Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
Jul 15, 2026
Summary
Effective November 1, 2026, CPT code A9552 (Fluorodeoxyglucose F-18 FDG diagnostic) now requires prior authorization through Carelon Medical Benefits Management for New York Medicaid patients. Billing teams must implement prior authorization checks for this nuclear medicine code before the effective date to avoid claim denials.
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What to do
by Oct 15, 2026 · 5 steps
01Billing team must update billing software and claim submission workflows to require prior authorization for CPT code A9552 (FDG diagnostic) for all New York Medicaid patients.
02Configure system rules to flag A9552 claims for mandatory PA submission to Carelon Medical Benefits Management before processing.
03Providers should submit PAs via the Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com).
04Failure to obtain prior authorization will result in claim denials.
05Update billing staff and providers on the new requirement immediately.
Codes mentioned
A9552
Original notice
[New York] Prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
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