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[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective date
Jan 1, 2027
Identified
Sep 25, 2026
Summary
Starting for dates of service on or after January 1, 2027, Carelon will require precertification or prior authorization for a set of skin graft and skin substitute codes, several transoral esophagoscopy procedures, and two neurostimulator generator codes for Anthem Blue Cross Medicare Advantage members in Ohio. The source says these services are being added to the review program to support consistent application of current clinical guidelines.
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What to do
Action · 4 steps
01Before January 1, 2027 (dates of service on or after): Billing team should add the listed codes to the Anthem Medicare Advantage precertification list for Ohio members, and set up a prior auth tracker entry for each.
02Providers and front desk staff should request Carelon precertification before scheduling any of these procedures or skin substitute applications for these members, including the per-square-centimeter add-on codes in the Q4182 to Q4423 range, the autologous skin-construct codes 1044T to 1049T, and the esophagoscopy codes 43192, 43201, 43210, 43236, 43257 and 43497.
03Billing team should record the precertification number in charge entry for these claims, and confirm the wound surface area or graft measurements in the documentation match the approved request.
04Watch for Carelon's updated criteria or list before the effective date.
Codes mentioned
431924320143210432364325743497A2036A2037A2038A2039A2040A2041A2042A2043A2044A2045C1826C1827G0681G0682G0683G0684Q4182Q4368Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382Q4383Q4384Q4385Q4386Q4387Q4388Q4389Q4390Q4392Q4393Q4394Q4395Q4396Q4397Q4398Q4399Q4400Q4401Q4402Q4403Q4404Q4405Q4406Q4407Q4408Q4409Q4410Q4411Q4412Q4413Q4414Q4415Q4416Q4417Q4418Q4419Q4420Q4421Q4422Q4423
Original notice
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Jan 1, 2027 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Jan 1, 2027 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list
Related policy hubs
Anthem BCBS policiesOH policy changesWound CareGeneral SurgeryGastroenterologyPlastic SurgeryNeurosurgeryCode 43192Code 43201Code 43210Code 43236Code 43257Code 43497Code A2036Code A2037Code A2038Code A2039Code A2040Code A2041Code A2042Code A2043Code A2044Code A2045Code C1826Code C1827Code G0681Code G0682Code G0683Code G0684Code Q4182Code Q4368Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4382Code Q4383Code Q4384Code Q4385Code Q4386Code Q4387Code Q4388Code Q4389Code Q4390Code Q4392Code Q4393Code Q4394Code Q4395Code Q4396Code Q4397Code Q4398Code Q4399Code Q4400Code Q4401Code Q4402Code Q4403Code Q4404Code Q4405Code Q4406Code Q4407Code Q4408Code Q4409Code Q4410Code Q4411Code Q4412Code Q4413Code Q4414Code Q4415Code Q4416Code Q4417Code Q4418Code Q4419Code Q4420Code Q4421Code Q4422Code Q4423