Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Sleep Medicine, Neurosurgery·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
May 27, 2026
Summary
Effective September 1, 2026, sleep neurostimulator code C1607 will require precertification/prior authorization through Carelon Medical Benefits Management for Medicare Advantage plans in Georgia. Billing teams must submit authorization requests via Carelon's provider portal or Availity before scheduling or billing for this implantable device.
Action Required
By August 31, 2026: Billing team and providers must update workflows to require prior authorization for HCPCS code C1607 (neurostimulator, integrated implantable, rechargeable). Before any C1607 procedures are scheduled for dates on or after September 1, 2026, submit precertification requests to Carelon Medical Benefits Management via the provider portal at https://providerportal.com or through Availity at https://Availity.com. Update all encounter forms, scheduling systems, and billing software to flag C1607 as requiring prior authorization. Ensure ordering and servicing providers are notified of this requirement. Claims submitted without prior authorization will be subject to denial.