CommercialPrior AuthMedium impact
[Virginia] Carelon Medical Benefits Management, Inc. Code Update
Anthem BCBS·VA · Orthopedics, Wound Care, General Surgery +2 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 7, 2026
Summary
Effective April 1, 2026, Carelon Medical Benefits Management will require prior authorization for 30 specific HCPCS and CPT codes related to tibial nerve stimulators, autografts, and tissue/membrane products for Anthem Blue Cross and Blue Shield commercial plans in Virginia. Billing teams must update systems to flag these codes for prior auth requests before the effective date.
Action Required
Before April 1, 2026: Billing team must update billing system to require prior authorization for all 27 listed HCPCS and CPT codes when billed to Anthem Blue Cross/HealthKeepers plans in Virginia. Configure system alerts to automatically flag these codes at claim entry. Educate ordering providers and clinical staff that prior auth requests must be submitted through Carelon's ProviderPortal (providerportal.com) or Availity Essentials platform before services are rendered. Claims lacking prior authorization will be denied. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com with policy questions.