CommercialPrior AuthHigh impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Gastroenterology·Provider Bulletin
Effective date
Feb 1, 2027
We identified it
Sep 24, 2026
Summary
Effective February 1, 2027, Carelon Medical Benefits Management will require prior authorization for 23 esophagogastroduodenoscopy (EGD) CPT codes for Anthem Blue Cross and Blue Shield commercial plans in New York. These codes—including diagnostic, therapeutic, and interventional EGD procedures—are being added to the precertification review program to ensure consistent application of clinical guidelines and evidence-based coverage criteria.
Action Required
By January 31, 2027: Billing team must update billing software to require prior authorization through Carelon Medical Benefits Management for all 23 EGD CPT codes (0652T, 0653T, 0654T, 43233, 43235, 43236, 43239, 43241, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43254, 43255, 43266, 43270) for Anthem Blue Cross and Blue Shield commercial plans in New York. Providers and gastroenterology staff must submit precertification requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before scheduling or performing these procedures. Claims submitted without prior authorization will be denied. Update encounter templates and provider communication to remind ordering providers of the new requirement.