Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·CA · 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 with all implantable and external components including charging system) now requires precertification/prior authorization through Carelon Medical Benefits Management for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers must submit authorization requests before delivering this service to avoid claim denials.
Action Required
By October 15, 2026: Billing team must update billing software and encounter forms to require prior authorization for CPT C1607 for all Anthem Blue Cross Medicare Advantage PPO plans in California. Providers and clinical staff should be notified of the new requirement. Starting November 1, 2026, all orders for CPT C1607 must be submitted to Carelon Medical Benefits Management for precertification via the provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com) before service delivery. Claims submitted without prior authorization will be denied. Implement internal workflow to ensure no C1607 procedures proceed without documented Carelon approval.