Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listed
Anthem BCBS·GA · Gastroenterology, Critical Care, General Surgery +3 more·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
May 27, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross Blue Shield in Georgia is adding prior authorization requirements for 20 parenteral nutrition codes (HCPCS B-series and 5000/5100/5200 codes) under Medicare Advantage and Group Retiree plans. Claims that do not meet CMS LCD L38953 criteria (primarily requiring documentation of permanently nonfunctioning gastrointestinal tract) will be denied as ineligible for reimbursement.
Action Required
By June 30, 2026: Billing team must update billing system to require prior authorization for all 19 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) for Anthem Medicare Advantage and Group Retiree Solution members in Georgia only. Clinical staff must ensure provider documentation includes evidence of permanently nonfunctioning gastrointestinal tract per CMS LCD L38953 before claims submission. Review CMS LCD L38953 criteria to identify which parenteral nutrition cases meet medical necessity threshold. Establish process to submit prior authorization requests through Availity Essentials or contact Provider Services. Claims submitted without meeting prior authorization requirements or lacking LCD L38953-compliant documentation will be denied as ineligible for payment.