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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · GA · Gastroenterology, Critical Care, General Surgery +3 moreMedium impact

[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listed

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
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.

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What to do

by Jun 30, 2026 · 5 steps
01Billing 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.
02Clinical staff must ensure provider documentation includes evidence of permanently nonfunctioning gastrointestinal tract per CMS LCD L38953 before claims submission.
03Review CMS LCD L38953 criteria to identify which parenteral nutrition cases meet medical necessity threshold.
04Establish process to submit prior authorization requests through Availity Essentials or contact Provider Services.
05Claims submitted without meeting prior authorization requirements or lacking LCD L38953-compliant documentation will be denied as ineligible for payment.

Codes mentioned

B4164B4168B4172B4176B4178B4180B4185B4187B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listed
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[California] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization change to the parenteral nutrition codes listedHighEffective Jul 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesGA policy changesGastroenterologyCritical CareGeneral SurgeryInternal MedicineOncologyPalliative CareCode B4164Code B4168Code B4172Code B4176Code B4178Code B4180Code B4185Code B4187Code B4189Code B4193Code B4197Code B4199Code B4216Code B4220Code B4222Code B4224Code B5000Code B5100Code B5200

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