MedicaidPrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Neurosurgery, Neurology, Sleep Medicine·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jun 19, 2026
Summary
Starting August 1, 2026, CPT code C1607 (integrated neurostimulator implant) will require precertification/prior authorization through Carelon Medical Benefits Management for New York Medicaid patients. Providers must obtain authorization before performing these procedures to avoid claim denials.
Action Required
By August 1, 2026: Billing team and providers must update systems to require prior authorization for CPT code C1607 (neurostimulator implants) for New York Medicaid patients. Submit authorization requests through Carelon's provider portal at https://providerportal.com or via Availity Essentials. Update encounter forms and EMR templates to alert providers. Claims without prior authorization will be denied.