Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·CA · 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) will require precertification/prior authorization through Carelon Medical Benefits Management for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers must obtain approval before ordering this genetic/molecular testing.
Action Required
By October 15, 2026: Billing team must update billing system and encounter forms to flag CPT code 0600U as requiring prior authorization for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers and clinical staff must be notified that this code now requires precertification. Implement workflow to submit all 0600U requests to Carelon Medical Benefits Management via their provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before patient testing. Claims submitted without prior authorization will be denied. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for guideline questions.