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[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Act
by Feb 1, 2027
Effective date
Feb 1, 2027
Identified
Oct 7, 2026
Summary
Effective February 1, 2027, Carelon Medical Benefits Management will add CPT code E0765 (FDA-approved nerve stimulator for treatment of nausea and vomiting) to its precertification/prior authorization requirements for Anthem Blue Cross and Blue Shield commercial plans in Georgia. Ordering and servicing providers must submit prior authorization requests through Carelon's provider portal, Availity Essentials, or email before delivering this service.
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What to do
by Feb 1, 2027 · 5 steps
01Billing and clinical teams should implement prior authorization workflows for CPT code E0765 in all Anthem Blue Cross and Blue Shield commercial claims for Georgia members.
02Update billing system and claim submission processes to flag E0765 for mandatory precertification before service delivery.
03Instruct ordering and servicing providers to submit authorization requests via Carelon's provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com) prior to patient treatment.
04Retain documentation of authorization approval in the patient record.
05Claims submitted without prior authorization for E0765 on or after February 1, 2027 will be subject to denial.
Codes mentioned
E0765
Original notice
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
Related changes
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