Policy Updates Prior AuthorizationMedicaidJune 5, 2023

Carelon Medical Benefits Management, Inc. genetic testing CPT code list update

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective for dates of service on and after October 1, 2023, the following codes will require prior authorization through Carelon Medical Benefits Management, Inc.*

CPT® code

Description

81349

Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis

81355

Vkorc1 (Vitamin K Epoxide Reductase Complex, Subunit 1) (for example, Warfarin Metabolism), Gene Analysis, Common Variants (for example, -1639/3673)

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon Medical Benefits Management through the process below:

  • Access the Carelon Medical Benefits Management ProviderPortalSM directly at providerportal.com:
    • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

If you have questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

On March 1, 2023, AIM Specialty Health® began operating as Carelon Medical Benefits Management, Inc.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

NYBCBS-CD-023037-23-CPN22847

PUBLICATIONS: July 2023 Provider Newsletter