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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OH · Gastroenterology, General Surgery, Internal Medicine +3 moreMedium impact

[Ohio] 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 Medicare Advantage plans in Ohio will require precertification/prior authorization for 20 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) aligned with CMS LCD L38953. Claims lacking prior authorization approval may be denied as ineligible for payment.

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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 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.
02Before 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.
03Providers must ensure documentation aligns with LCD L38953 medical necessity requirements.
04Failure to obtain required prior authorization will result in claim denials and ineligible for payment determinations.
05Update encounter forms and internal workflows to prompt clinical staff to communicate medical justification to billing team before service delivery.

Codes mentioned

B4164B4168B4172B4176B4178B4180B4185B4187B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

[Ohio] 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[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[Georgia] 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 policiesOH policy changesGastroenterologyGeneral SurgeryInternal MedicineCritical CareOncologyPalliative CareCode B4164Code B4168Code B4172Code B4176Code B4178Code B4180Code B4185Code B4187Code B4189Code B4193Code B4197Code B4199Code B4216Code B4220Code B4222Code B4224Code B5000Code B5100Code B5200

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