CommercialPrior AuthLow impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Dermatology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 6, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Ohio now requires prior authorization/precertification for CPT code 1020T (Raman spectroscopy of skin lesions for malignant risk assessment) through Carelon Medical Benefits Management. This is a new code addition to the prior authorization requirements list.
Action Required
By November 15, 2026: Billing team must update billing system rules to require prior authorization for CPT 1020T when submitted to Anthem Blue Cross and Blue Shield in Ohio. Providers ordering this procedure must submit precertification requests via Carelon's provider portal (https://providerportal.com) or through Availity Essentials (https://Availity.com) before service delivery. Update encounter forms and provider communications to indicate prior auth requirement. Claims for CPT 1020T submitted without prior authorization will be denied.