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Anthem BCBSCommercial · Prior Auth · Provider Bulletin · NY · Pain Management, GastroenterologyMedium impact

[New York] 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, CPT code E0765 (FDA-approved nerve stimulator for treatment of nausea and vomiting) will require precertification/prior authorization through Carelon Medical Benefits Management for Commercial plans in New York. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before providing this service.

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What to do

by Feb 1, 2027 · 3 steps
01Billing team and ordering providers must implement prior authorization requirement for CPT code E0765 for Commercial plan members in New York.
02Before dates of service on or after February 1, 2027, providers must submit precertification requests to Carelon Medical Benefits Management via: (1) Carelon provider portal at https://providerportal.com (24/7 access, real-time processing—preferred method), (2) Availity Essentials at https://Availity.com, or (3) email at MedicalBenefitsManagement.guidelines@Carelon.com.
03Update billing workflows to flag E0765 claims for Commercial New York members and ensure prior authorization is obtained before service delivery.
If missed: Failure to obtain prior authorization may result in claim denial.

Codes mentioned

E0765

Original notice

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Feb 1, 2027 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementLowEffective Feb 1, 2027 · Provider Bulletin[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Feb 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesPain ManagementGastroenterologyCode E0765

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