CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Dermatology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 7, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (including HealthKeepers, Inc.) in Virginia will require prior authorization through Carelon Medical Benefits Management for CPT code 1020T (Raman spectroscopy of skin lesions with malignant risk analysis). This applies to all PPO and HMO commercial plans in Virginia. Billing teams must update authorization workflows to route this procedure through Carelon before service delivery.
Action Required
By November 1, 2026: Billing team must implement prior authorization requirement for CPT 1020T in the billing system and update provider order entry workflows. Add CPT 1020T to the list of codes requiring Carelon Medical Benefits Management pre-certification before service delivery for all Anthem/HealthKeepers Virginia commercial plans (PPO and HMO). Update encounter forms and provider notifications to flag this code. Providers must submit pre-certification requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) at least 24-48 hours before scheduling. Claims for CPT 1020T submitted without prior authorization will be denied. Train front desk and clinical staff on new workflow.