MedicaidPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Sleep Medicine, Neurology·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jun 19, 2026
Summary
Starting August 1, 2026, Virginia Medicaid will require precertification/prior authorization for CPT code C1607 (rechargeable neurostimulator implant) through Carelon Medical Benefits Management. This affects sleep medicine procedures involving implantable neurostimulator devices.
Action Required
Before August 1, 2026: Billing team must update system to require prior authorization for CPT C1607 through Carelon Medical Benefits Management for Virginia Medicaid patients. Update encounter forms to remind providers. Submit authorization requests via Carelon provider portal at https://providerportal.com or through Availity Essentials. Claims will be denied without prior authorization.