CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Cardiology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 13, 2026
Summary
Effective December 1, 2026, Carelon Medical Benefits Management now requires prior authorization for CPT code K0606 (automatic external defibrillator with integrated electrocardiogram analysis, garment type) for Anthem Blue Cross and Blue Shield commercial plans in New York. This code is being added to the precertification review program to ensure consistent application of clinical guidelines and evidence-based coverage criteria.
Action Required
By November 30, 2026: Billing team must update all systems and workflow processes to require prior authorization for CPT K0606 before claims submission. (1) Update billing software to flag K0606 as requiring precertification for Anthem commercial plans in New York. (2) Notify ordering and servicing providers that K0606 now requires prior auth submission to Carelon Medical Benefits Management. (3) Establish protocol for submitting prior authorization requests either through Carelon's provider portal (https://providerportal.com, 24/7 access) or via Availity Essentials (https://Availity.com). (4) Update encounter forms and ordering templates to remind providers of the new requirement. (5) Direct questions about coverage guidelines to MedicalBenefitsManagement.guidelines@Carelon.com. Failure to obtain prior authorization for K0606 will result in claim denials.