MedicaidPrior AuthMedium impact
[Ohio] Prior authorization requirement changes
Anthem BCBS·OH · Neurosurgery, Pain Management, PM&R (Physical Medicine & Rehab)·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 29, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicaid in Ohio is adding prior authorization requirements for two neurostimulator generator codes (C1826 and C1827). Billing teams must obtain precertification before submitting claims for these implantable neurostimulator devices, or claims will be denied as ineligible for payment.
Action Required
By December 31, 2026: Billing team must update billing software and encounter forms to require prior authorization for HCPCS codes C1826 and C1827 for all Ohio Medicaid Managed Care claims submitted to Anthem. Providers must submit precertification requests via Availity Essentials (https://Availity.com), fax to 877-643-0672, or phone 800-601-9935 BEFORE billing these codes. Update internal protocols to flag these codes for prior auth verification. Failure to obtain prior authorization will result in claim denials and services being deemed ineligible for payment.