Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · 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) will require precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Ohio. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing these procedures.
Action Required
By October 31, 2026: Billing team and clinical staff must implement prior authorization requirement for CPT C1607 in the billing system and provider workflows for all Anthem Blue Cross and Blue Shield Medicare Advantage patients in Ohio. Add C1607 to the precertification checklist on encounter forms and surgical scheduling templates. Providers and clinical staff must submit precertification requests to Carelon Medical Benefits Management via: (1) Provider portal at https://providerportal.com (24/7 real-time access), (2) Availity Essentials at https://Availity.com, or (3) Email to MedicalBenefitsManagement.guidelines@Carelon.com. Configure billing software to flag claims for C1607 without prior authorization documentation. Claims submitted without prior authorization will be denied. UM AROW reference number: A2026M6037.