CommercialPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Plastic Surgery, Wound Care, General Surgery +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 plans will require precertification/prior authorization through Carelon Medical Benefits Management for 74 specific billing codes related to autologous skin-construct grafts, skin substitute products, and neurostimulator generators. Billing teams must update their prior authorization workflows to include these codes for dates of service on or after the effective date.
Action Required
By February 1, 2027: Billing team must update the billing system and prior authorization workflows to require precertification/prior authorization through Carelon Medical Benefits Management for all 74 specified codes (1044T–1049T, A2036–A2045, C1826–C1827, G0681–G0684, Q4182, Q4368–Q4426) for Anthem Blue Cross and Blue Shield Commercial plan members in Ohio. Verify that the practice's scheduling and prior authorization submission processes flag these codes for Carelon review before services are rendered on or after the effective date. Claims for these services without prior authorization may be subject to denial.