Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Neurosurgery, Pain Management·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 14, 2026
Summary
Effective November 1, 2026, CPT code C1607 (Neurostimulator, integrated rechargeable implantable) now requires precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia. Billing teams must route all C1607 claims through Carelon before service delivery to avoid denials.
Action Required
Before November 1, 2026: (1) Billing team must update all systems to flag CPT code C1607 as requiring prior authorization for Anthem BCBS Medicare Advantage Georgia members. (2) Configure billing software to route C1607 authorization requests through Carelon Medical Benefits Management provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). (3) Notify ordering and servicing providers (particularly neurosurgeons and pain management specialists) that C1607 implants require precertification submission before scheduling. (4) Add C1607 to pre-visit planning checklists for procedures involving neurostimulator implants. Failure to obtain prior authorization will result in claim denials. Reference UM AROW #A2026M6037 for Carelon inquiries.