CommercialPrior AuthLow impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Cardiology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 13, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (Virginia) now requires prior authorization through Carelon Medical Benefits Management for CPT code K0606 (automatic external defibrillator with integrated electrocardiogram analysis, garment type). This is a new addition to the precertification review program for cardiovascular devices.
Action Required
By November 30, 2026: Billing team and ordering providers must update workflows to require prior authorization for CPT K0606 before submitting claims to Anthem Blue Cross and Blue Shield Virginia. Submit all precertification requests via Carelon Medical Benefits Management provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Update internal billing system rules and provider documentation to reflect this new authorization requirement. Claims for K0606 services with dates of service on or after December 1, 2026 submitted without prior authorization will be denied by Carelon Medical Benefits Management.