CommercialPrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·CA · Nephrology, Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 13, 2026
Summary
Effective October 1, 2026, two specific genetic testing codes (0628U for kidney disease genetic testing and 0630U for breast cancer genetic profiling) will require precertification/prior authorization through Carelon Medical Benefits Management for all California PPO plans.
Action Required
Before October 1, 2026: Billing team must update system to require prior authorization for codes 0628U and 0630U through Carelon Medical Benefits Management for all California PPO patients. Staff should use the Carelon provider portal at https://providerportal.com or access via Availity Essentials. Update encounter forms and notify providers that these genetic tests require precertification. Claims will be denied without proper authorization.