CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · 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 in Ohio is adding CPT code K0606 (Automatic external defibrillator with integrated electrocardiogram analysis, garment type) to the list of services requiring precertification/prior authorization through Carelon Medical Benefits Management. This change applies to commercial plans and requires providers to obtain approval before billing this service.
Action Required
By November 15, 2026: Billing team must update the billing system to require prior authorization for CPT code K0606 before claims are submitted. Update encounter forms and provider reminders to alert ordering and servicing providers that K0606 now requires precertification. Providers must submit prior authorization requests through either the Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before dispensing or billing this device. Failure to obtain prior authorization will result in claim denials. Contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com for clinical guideline questions.