Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Nephrology, Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 13, 2026
Summary
Starting October 1, 2026, two genetic testing codes (0628U for kidney disease and 0630U for breast cancer) will require prior authorization through Carelon Medical Benefits Management for Georgia Medicare Advantage plans. Providers must obtain authorization before performing these tests to avoid claim denials.
Action Required
By October 1, 2026: Billing team must update system to require prior authorization for codes 0628U and 0630U through Carelon Medical Benefits Management. Update encounter forms and EMR to remind providers about authorization requirement for these genetic tests. Submit requests via Carelon provider portal at https://providerportal.com or through Availity Essentials. Claims submitted without prior authorization will be denied.