MedicaidPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Neurology, Neurosurgery, Sleep Medicine·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 19, 2026
Summary
Effective October 1, 2026, CPT code C1607 (neurostimulator, integrated implantable, rechargeable) will require precertification/prior authorization through Carelon Medical Benefits Management for Ohio Medicaid patients. Providers can submit authorization requests through Carelon's provider portal or Availity Essentials.
Action Required
By October 1, 2026: Billing team must update system to require prior authorization for CPT code C1607 (neurostimulator implants) for Ohio Medicaid patients. Update encounter forms and EMR templates to alert providers. Submit authorization requests through Carelon Medical Benefits Management portal at https://providerportal.com or via Availity Essentials. Claims submitted without prior authorization will be denied.