CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Plastic Surgery, Wound Care, Dermatology +2 more·Provider Bulletin
Effective date
Feb 1, 2027
We identified it
Oct 7, 2026
Summary
Effective February 1, 2027, Anthem Blue Cross and Blue Shield (Commercial) will require precertification/prior authorization through Carelon Medical Benefits Management for autologous skin-construct graft procedures, skin substitute applications, neurostimulator generators, and numerous skin substitute products. These services are being added to the review program to ensure consistent application of current clinical guidelines and evidence-based coverage criteria.
Action Required
By February 1, 2027: Billing team must implement prior authorization requirement for all 77 affected CPT and HCPCS codes (1044T–1049T, A2036–A2045, C1826–C1827, G0681–G0684, Q4182–Q4427) when submitted to Anthem Blue Cross and Blue Shield Commercial plans in Georgia. Update billing software or prior authorization submission processes to require Carelon Medical Benefits Management authorization before claims are submitted for dates of service on or after February 1, 2027. Notify providers in relevant specialties (plastic surgery, wound care, pain management) that these procedures now require precertification. Claims submitted without prior authorization may be denied.