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

By June 30, 2026: Billing team must update billing system to require prior authorization for all 19 parenteral nutrition codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) when submitting claims to Anthem Medicare Advantage plans for Ohio members. Before submitting any of these codes on or after July 1, 2026, obtain and document prior authorization approval by submitting medical records demonstrating a permanently nonfunctioning gastrointestinal tract per CMS LCD L38953 criteria via Availity Essentials or by calling Provider Services. Providers must ensure documentation aligns with LCD L38953 medical necessity requirements. Failure to obtain required prior authorization will result in claim denials and ineligible for payment determinations. Update encounter forms and internal workflows to prompt clinical staff to communicate medical justification to billing team before service delivery.