CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·OH · Urology, Bariatric Surgery, Neurology +1 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (Ohio) is adding four new codes to Carelon Medical Benefits Management's prior authorization requirements: two neurostimulation system codes (0988T, 0989T), one bariatric surgery code (43889), and one neurostimulator device code (C1607). All requests for these procedures must be precertified through Carelon before service delivery to avoid claim denials.
Action Required
By October 31, 2026: Billing team must update billing software and authorization workflows to require prior authorization through Carelon Medical Benefits Management for CPT codes 0988T, 0989T, 43889, and HCPCS code C1607. Providers and clinical staff should be notified that these procedures cannot be scheduled without obtaining precertification first. Update encounter forms and pre-visit planning templates to flag these codes for mandatory prior auth submission. Submit all authorization requests via Carelon's provider portal at https://providerportal.com or through Availity Essentials at https://Availity.com. Claims submitted without prior authorization for these codes will be denied by Anthem BCBS in Ohio. For guideline questions, contact MedicalBenefitsManagement.guidelines@Carelon.com.