MedicaidPrior AuthMedium impact
[New York] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Nuclear Medicine, Radiology, Oncology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
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.
Action Required
By October 15, 2026: Billing 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. Configure system rules to flag A9552 claims for mandatory PA submission to Carelon Medical Benefits Management before processing. Providers should submit PAs via the Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Failure to obtain prior authorization will result in claim denials. Update billing staff and providers on the new requirement immediately.