CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·GA · Urology, Bariatric Surgery, Gastroenterology +1 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross Blue Shield in Georgia is adding four specific surgical and device codes to Carelon Medical Benefits Management's prior authorization requirements. Providers must obtain precertification before performing these procedures: two neurostimulation procedures for bladder dysfunction (CPT 0988T, 0989T), endoscopic sleeve gastroplasty (CPT 43889), and an integrated neurostimulator device (HCPCS C1607). Claims submitted without prior authorization will be denied.
Action Required
Before November 1, 2026: Billing team must update prior authorization protocols to require Carelon Medical Benefits Management precertification for CPT codes 0988T, 0989T, 43889, and HCPCS code C1607. Update billing system rules and encounter forms to flag these codes for mandatory prior auth submission. Providers should submit requests through Carelon's provider portal (https://providerportal.com) or via Availity Essentials (https://Availity.com). Train clinical and billing staff that these procedures cannot be scheduled or billed without prior authorization approval. Failure to obtain prior authorization will result in claim denials for Georgia Anthem Blue Cross Blue Shield commercial patients.