CommercialPrior AuthMedium impact
[Georgia] Carelon Medical Benefits Management, Inc. Code Update
Anthem BCBS·GA · Orthopedics, Wound Care, Podiatry +3 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Carelon Medical Benefits Management will require prior authorization for 30 specific CPT and HCPCS codes related to tibial nerve stimulators, autografts, and advanced wound care/tissue matrices for Georgia commercial plans. Billing teams must implement prior authorization requirements in their systems and submission workflows for these codes.
Action Required
By March 31, 2026: Billing team must update billing system and encounter forms to require prior authorization for all 27 specified HCPCS and CPT codes (A4545, E0736, E0737, C1832, Q4334-Q4367, A2030-A2035, C1763) when submitted to Carelon Medical Benefits Management for Georgia commercial patients. Configure submission workflows to route these codes to Carelon's ProviderPortal (providerportal.com) or Availity Essentials (Availity.com) for prior authorization processing before claim submission. Train ordering and servicing providers that prior authorization must be obtained before delivering these supplies, biologics, and devices. Failure to obtain prior authorization will result in claim denials.