Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·CA · Neurosurgery, Pain Management·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
May 27, 2026
Summary
Effective September 1, 2026, HCPCS code C1607 (Neurostimulator, integrated implantable rechargeable) now requires precertification/prior authorization through Carelon Medical Benefits Management for all California PPO plans. Billing teams must implement prior auth requirements in their systems and ensure providers submit authorization requests before scheduling or performing this procedure.
Action Required
By August 15, 2026: Billing team must update the billing system to flag HCPCS code C1607 as requiring prior authorization through Carelon Medical Benefits Management for all California PPO members. Update encounter forms and provider templates to remind ordering and servicing providers to obtain precertification before implantation. Providers must submit authorization requests via Carelon's provider portal (https://providerportal.com) or through Availity Essentials (https://Availity.com). Train front desk and authorization staff on new requirement. Failure to obtain prior authorization will result in claim denials for C1607 procedures performed on or after September 1, 2026.