Medicare AdvantagePrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · 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 implant) will require precertification/prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Medicare Advantage plans in New York. Providers must submit authorization requests via Carelon's provider portal, Availity Essentials, or email before performing procedures with this code.
Action Required
By October 1, 2026: Billing team must update prior authorization requirements in the billing system to flag CPT code C1607 for Anthem Blue Cross Medicare Advantage patients in New York. Providers and front desk staff should be notified that all C1607 procedures require precertification before scheduling. Establish workflow to submit authorization requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Add reminder in EMR/encounter forms for ordering providers. Update internal templates and checklists. Without prior authorization, claims for C1607 will be denied by Anthem Blue Cross Medicare Advantage. Contact Carelon for guideline questions at MedicalBenefitsManagement.guidelines@Carelon.com.