CommercialPrior AuthHigh impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Gastroenterology, General Surgery, Internal Medicine·Provider Bulletin
Effective date
Feb 1, 2027
We identified it
Sep 24, 2026
Summary
Effective February 1, 2027, Anthem Blue Cross and Blue Shield (Georgia) is adding 24 esophagogastroduodenoscopy (EGD) procedure codes to the prior authorization requirement list through Carelon Medical Benefits Management. All transnasal and transoral EGD procedures with various therapeutic and diagnostic interventions now require precertification before service delivery to ensure alignment with clinical guidelines and coverage criteria.
Action Required
By January 31, 2027: Billing team and providers must implement prior authorization requirements for all 24 EGD-related CPT codes (0652T, 0653T, 0654T, 43233, 43235, 43236, 43239, 43241, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43254, 43255, 43266, 43270) for Anthem Blue Cross and Blue Shield Georgia commercial plans. Update billing software to flag these codes for mandatory prior authorization submission. Providers must submit precertification requests through Carelon Medical Benefits Management via the provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) BEFORE scheduling or performing these procedures. Front desk staff should add precertification reminders to encounter forms and scheduling workflows. Claims submitted without prior authorization will be denied and require resubmission after authorization is obtained.