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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Neurosurgery, Pain ManagementMedium impact

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
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.

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What to do

by Oct 15, 2026 · 5 steps
01Billing 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.
02Providers and clinical staff should be notified of the new requirement.
03Starting 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.
04Claims submitted without prior authorization will be denied.
05Implement internal workflow to ensure no C1607 procedures proceed without documented Carelon approval.

Codes mentioned

C1607

Original notice

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Nov 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesCA policy changesNeurosurgeryPain ManagementCode C1607

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