CommercialPrior AuthHigh impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Dermatology, General Surgery, Plastic Surgery +2 more·Provider Bulletin
Effective date
Feb 1, 2027
We identified it
Oct 7, 2026
Summary
Effective February 1, 2027, Carelon Medical Benefits Management will require prior authorization for a comprehensive list of skin graft and wound care procedure codes (CPT codes 1044T–1049T, HCPCS codes A2036–A2045, C1826–C1827, G0681–G0684, and Q4182–Q4427) for Commercial plans in New York. These codes are being added to the precertification review program to ensure consistent application of current clinical guidelines and evidence-based coverage criteria.
Action Required
By February 1, 2027: Billing team must implement prior authorization requirements in the billing system for all listed skin graft and wound care codes (1044T–1049T, A2036–A2045, C1826–C1827, G0681–G0684, and Q4182–Q4427) for Carelon Commercial members in New York. Front-office and clinical staff should verify that encounter forms and referral workflows route these procedures to Carelon Medical Benefits Management for precertification before scheduling or performing the service. Claims submitted without prior authorization for these codes on or after February 1, 2027 will be subject to denial.