Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · 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) now requires precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Virginia. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing this procedure.
Action Required
By November 1, 2026: Billing team and providers must obtain prior authorization from Carelon Medical Benefits Management before implanting neurostimulator code C1607 for Medicare Advantage beneficiaries. Update billing software and provider workflows to flag C1607 as requiring precertification. Submit authorization requests via Carelon provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com). Claims submitted without prior authorization will be denied. Notify all providers performing neurostimulator implants of this requirement immediately.