CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization requirements — Carelon Medical Benefits Management
Anthem BCBS·NY · Urology, Bariatric Surgery, Gastroenterology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (through Carelon Medical Benefits Management) now requires prior authorization for four specific surgical codes: bladder dysfunction neurostimulation procedures (CPT 0988T, 0989T), transoral endoscopic sleeve gastroplasty (CPT 43889), and the integrated neurostimulator device (HCPCS C1607). All ordering and servicing providers must obtain precertification before performing these procedures or face potential claim denials.
Action Required
By October 15, 2026: Billing team and clinical staff must update internal systems and workflows to require prior authorization through Carelon Medical Benefits Management for CPT codes 0988T, 0989T, 43889, and HCPCS code C1607. Update encounter forms, clinical templates, and billing software rules to flag these codes for mandatory pre-service authorization before claims submission. Providers must submit authorization requests via Carelon's provider portal (https://providerportal.com) or through Availity Essentials (https://Availity.com). Train all clinical and front-desk staff to verify authorization completion before scheduling or performing these procedures. Failure to obtain prior authorization will result in claim denials and potential financial liability.