What insurance policy changes affect Georgia providers?

This page tracks changes from major payers (including Medicaid managed care, commercial insurers, and Medicare Advantage plans) that explicitly apply to Georgia. Changes include prior authorization updates, billing code additions or deletions, and reimbursement rate revisions.

How often are Georgia policy changes updated?

Our scrapers run daily and publish new findings within 24 hours of detection. Each change includes an effective date where stated so you can prioritize what requires immediate action.

How do I get alerted to new Georgia insurance policy changes?

Create a free alert on PolicyChanges.app and filter by state to Georgia. You will get an email when new matching changes are detected: daily or weekly, your choice, on every plan.

PAYER POLICY CHANGES

Georgia Insurance & Medicaid Policy Updates

Georgia providers face a continuous stream of payer policy changes: coverage edits, prior authorization expansions, billing code revisions, and Medicaid reimbursement updates that affect day-to-day practice operations. This page surfaces every tracked policy change that explicitly names Georgia, so your billing and compliance teams can act before the effective date, not after a claim denial.

Anthem BCBS · Effective Nov 15, 2026High impact
[Georgia] Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines
Carelon Medical Benefits Management updated clinical appropriateness guidelines effective November 15, 2026, with major changes to vascular procedures (adding new ablation modalities, revising criteria for embolization), PFO closure (age-based restrictions), and genetic/molecular testing for cancer (expanding indications for liquid biopsy, somatic tumor testing, and tissue-based molecular profiling across multiple cancer types). Billing teams must review affected procedure approvals and update documentation requirements for cancer-related genetic testing.
Anthem BCBS · Effective Nov 15, 2026High impact
[Georgia] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates
Carelon Medical Benefits Management updated its clinical appropriateness guidelines for Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia, effective for dates of service on and after November 15, 2026. Genetic testing changes require that all components of a test demonstrate clinical utility, add imlunestrant to the therapies for which ESR1 mutation testing is considered medically necessary, and state that testing for breast cancer recurrence is not medically necessary. Orthopedic changes standardize conservative management to 12 weeks across procedures, with an allowance for shorter duration for severe ADL impacts, and exclude Kellgren-Lawrence grade 4 osteoarthritis from shoulder, hip and knee arthroscopy.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] Include anatomical modifiers on outpatient facility claims
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Georgia will require anatomical modifiers (E1–E4, FA, F1–F9, TA, T1–T9, LC, LD, LM, RC, RI, LT, RT, 50) on outpatient facility claims for CPT and HCPCS codes that specify anatomical site identification. Claims missing required modifiers or with mismatched modifiers will not be eligible for reimbursement.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] Review Excludes1 coding before submitting claims
Effective December 1, 2026, Anthem Blue Cross and Blue Shield will enforce ICD-10-CM Excludes1 coding edits on all inpatient and outpatient claims for medical and behavioral health services in Georgia. Billing teams must review diagnosis coding guidance for Excludes1 Notes before claim submission to avoid conflicts that will render claims ineligible for reimbursement. Claims with unresolved Excludes1 conflicts will require correction and resubmission.
Anthem BCBS · Effective Dec 1, 2026High impact
[New York] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
Anthem Medicare Advantage is implementing a new reimbursement policy effective December 1, 2026, that prohibits pass-through laboratory billing (modifier 90) for professional and outpatient facility providers, requiring them to bill directly instead. The existing modifier 91 guidance for repeat clinical diagnostic laboratory tests remains unchanged and has been consolidated into this new combined policy.
Anthem BCBS · Effective Dec 1, 2026High impact
[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse outpatient medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 facility claim forms. These services are only reimbursable when submitted by the rendering provider on CMS-1500 professional claim forms using the applicable codes. Participating providers cannot balance bill members for this change.
Anthem BCBS · Effective Dec 1, 2026High impact
[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse outpatient medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 facility claims. These services are now eligible for reimbursement ONLY when submitted by the rendering provider on CMS-1500 (professional claim form). Billing teams must route these services to the correct claim form type to avoid denials.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] Specialty pharmacy updates
Anthem Blue Cross Blue Shield Georgia is implementing new prior authorization and quantity limit requirements for 5 specialty pharmacy drugs effective December 1, 2026, and revising clinical criteria for 11 additional specialty drugs. Billing teams must request prior authorization for affected medications and include NDC codes on claims to expedite processing; previously covered patients may require new authorization for continued medication use.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 (facility claims). These services are now eligible for reimbursement ONLY when submitted on CMS-1500 (professional claim form) by the rendering provider. Billing teams must immediately audit billing workflows to prevent claim denials and ensure correct claim form submission.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
Effective December 1, 2026, Anthem Medicare Advantage is implementing a new combined reimbursement policy (G-20001) that prohibits reimbursement for laboratory services billed with modifier 90 (pass-through billing). Providers must bill directly for laboratory services and will be reimbursed at 100% of the applicable fee schedule. The existing modifier 91 guidance for repeat clinical diagnostic laboratory tests remains unchanged and is consolidated into this new policy. The prior modifier 91 policy (G-06020) is being retired.
CareSource · Effective Dec 4, 2026High impact
[Georgia] Claims Editing Enhancements
CareSource Georgia Medicaid will implement enhanced claims editing effective December 4, 2026, adding new validation rules for modifier usage, E/M code bundling, lab tests, surgical pathology units, and DME replacement history. Claims that fail these edits will be denied.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] 2027 Medicare formulary changes: Prepare now for
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will move 10 select medications to nonformulary status, including common drugs for asthma, COPD, diabetes, anticoagulation, and inflammatory conditions. Practices must review affected patients before the effective date, transition them to covered alternatives where clinically appropriate, and submit prior authorization requests for any nonformulary medications that remain medically necessary.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield Georgia commercial plans are implementing expanded prior authorization (PA) requirements effective January 1, 2027, across inpatient admissions, advanced diagnostic testing, DME/prosthetics, transplants, gene therapies, CAR T-cell treatments, mental health services, and numerous outpatient surgical procedures. Billing teams must update systems to require PA authorization for these services before the effective date to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Review clinically integrated network participation requirements
Anthem Blue Cross and Blue Shield is implementing stricter enforcement of existing clinically integrated network (CIN) participation requirements effective January 1, 2027. Care providers, practices, and facilities can now participate through only one CIN per Anthem product; CINs must verify and resolve all overlapping affiliations before enrollment or face approval denial. This is a network enrollment process change, not a new requirement, but enforcement will be significantly increased.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Reimbursement policy update: Maternity Services coding changes
Effective January 1, 2027, Anthem Blue Cross and Blue Shield is restructuring maternity services coding for Georgia commercial plans. If CMS does not adopt proposed G-codes, maternity care will shift from global codes to granular reporting using separate antepartum, delivery, and postpartum codes with E/M codes, modifier TH, and frequency limits. The policy is contingent on CMS's decision; Anthem will provide updated guidance if CMS adopts alternative G-codes.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield is expanding prior authorization (PA) requirements effective January 1, 2027, for Georgia commercial accounts. The policy adds comprehensive PA requirements across multiple service categories including advanced diagnostic testing (genetic testing, liquid biopsy, whole genome sequencing), specialized DME/prosthetics (robotic devices, AAC devices, bone growth stimulation), gene replacement therapies, CAR T-cell immunotherapy treatments, and numerous surgical procedures. Billing teams must update systems to require PA for these newly-covered services to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)
Anthem Blue Cross and Blue Shield (Georgia) has updated prior authorization and precertification requirements for surgical procedures. Updates are effective January 1, 2027 for Commercial and Medicare Advantage Base Surgical lists, and February 1, 2027 for Commercial Surgical SOCs. The specific procedure changes are not detailed in this bulletin; providers must review the linked documentation for exact code requirements.
UnitedHealthcare · Effective Jan 1, 2027High impact
New oncology prior authorization code updates
Effective January 1, 2027, UnitedHealthcare is adding prior authorization requirements for 11 HCPCS oncology medication codes when administered in outpatient settings for cancer treatment. These codes include busulfan, leucovorin calcium, luspatercept, dexrazoxane, dinutuximab, octreotide, triptorelin, omidubicel, zoledronic acid, and cyclosporine. This change applies across commercial, Medicare Advantage, Medicaid, and Individual Exchange plans.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Specialty pharmacy updates
Anthem Blue Cross and Blue Shield in Georgia is implementing new prior authorization requirements for three specialty oncology medications (Avgemsi, Docivyx, and Beizray) effective January 1, 2027. Additionally, step therapy requirements are being applied to pemetrexed, bendamustine, and docetaxel products, with specific medications designated as preferred or non-preferred options. Patients currently receiving these medications without prior authorization may require PA review for continued coverage starting January 1, 2027.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will require prior authorization/precertification through Carelon Medical Benefits Management for 66 new billing codes spanning autologous skin grafts, esophageal procedures, neurostimulator devices, and advanced wound care products. Billing teams must update systems to require prior authorization for these codes before the effective date to prevent claim denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Peach State Health Plan will discontinue coverage for 45 HCPC H codes (H0003-H0047, H1011, H2001-H2033) commonly used for behavioral health, substance abuse treatment, and support services. Simultaneously, H0006 coverage will be newly activated. Practices must identify affected claims, update billing systems, and establish alternative coding or coverage verification processes before the effective date.
Anthem BCBS · Effective Feb 1, 2027High impact
[Georgia] New reimbursement policy: Inpatient Hospital Inclusive Services — Facility
Effective February 1, 2027, Anthem Blue Cross and Blue Shield in Georgia will no longer separately reimburse specific inpatient hospital services (including blood products, DME, nursing, pharmacy, therapy, radiology guidance, and professional services like catheter insertion and chemotherapy administration) when billed on the same date of service as an inpatient admission. Services must be reported correctly on CMS-1500/837P (professional) or UB-04 (facility) forms to avoid denial; balance billing members is prohibited.
Anthem BCBS · Effective Feb 1, 2027High impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective for dates of service on or after February 1, 2027, the listed codes will require precertification or prior authorization through Carelon Medical Benefits Management for Anthem Blue Cross and Blue Shield Commercial plans in Georgia. The added codes cover full-thickness skin harvest and autologous heterogeneous skin-construct graft application, a long list of skin substitute products, and neurostimulator generators (C1826 and C1827). These services are being added to the review program to support consistent application of current clinical guidelines and evidence-based coverage criteria.
Anthem BCBS · Effective Feb 1, 2027High impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective February 1, 2027, Anthem Blue Cross and Blue Shield (Georgia) is adding 24 esophagogastroduodenoscopy (EGD) procedure codes to the prior authorization requirement list through Carelon Medical Benefits Management. All transnasal and transoral EGD procedures with various therapeutic and diagnostic interventions now require precertification before service delivery to ensure alignment with clinical guidelines and coverage criteria.
Anthem BCBS · Effective Nov 15, 2026Medium impact
[Georgia] Carelon Medical Benefits Management updates
Anthem Blue Cross Blue Shield (Georgia) is transitioning to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective November 15, 2026. Two procedures are affected: Cardiovascular Catheter-Based Closure of Patent Foramen Ovale and Surgical Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy). Existing prior authorization requirements remain unchanged, but providers should monitor for future prior auth implementation notices.
Anthem BCBS · Effective Nov 29, 2026Medium impact
[Georgia] Clinical Criteria updates
Anthem Blue Cross and Blue Shield has revised 60 clinical criteria policies for medical drug benefits effective November 29, 2026. These revised criteria apply to Medicare Advantage members in Georgia and affect medical necessity requirements for a broad range of specialty drugs including biologics, oncology agents, and rare disease treatments. Billing teams must verify current authorization requirements through separate notices, as this bulletin informs of criteria changes but does not detail authorization procedures.
CareSource · Effective Dec 1, 2026Medium impact
[Georgia] Administrative/Medical Policy Update (1/2)
CareSource Georgia is releasing two policy updates effective December 1, 2026: a revision to the Cystic Fibrosis Testing administrative policy (AD-0842) and a new medical policy for Vein Embolization for Treatment of Pelvic Pain (MM-1844). The billing team must review both policies on the CareSource website to understand specific coverage, coding, and prior authorization requirements before the effective date.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Prior authorization required for MED.00164
Anthem Blue Cross and Blue Shield (Georgia) is adding MED.00164 (Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome) to its precertification requirements, effective December 1, 2026. Prior authorization must be obtained before providing this service to ensure accurate reimbursement and avoid claim denials.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)
Carelon Medical Benefits Management has updated prior authorization requirements for Georgia commercial plans, effective December 1, 2026. Updates affect Additional Outpatient and Cardiovascular services. The full policy details are available through the Anthem provider portal, but specific code changes are not included in this newsletter summary.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Precertification/prior authorization list change notification
Effective December 1, 2026, Anthem Blue Cross and Blue Shield Georgia is adding compression devices for lymphedema (HCPCS code E0659) to its precertification/prior authorization requirements for commercial plans. All claims for this service will require prior authorization approval before processing to avoid denials.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective December 1, 2026, Carelon Medical Benefits Management is adding CPT code K0606 (Automatic external defibrillator, with integrated electrocardiogram analysis, garment type) to the precertification/prior authorization requirement for Anthem Blue Cross and Blue Shield commercial plans in Georgia. All orders for this device will now require prior authorization before service delivery.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Precertification/prior authorization list change notification
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Georgia is adding three services to its precertification/prior authorization requirements: noninvasive imaging for skin lesion evaluation (CPT 1020T) and percutaneous spinal surgery procedures (CPT 62330 and 62331). Providers must obtain prior authorization before delivering these services or risk claim denials.
Anthem BCBS · Effective Dec 1, 2026Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (Georgia) now requires prior authorization through Carelon Medical Benefits Management for two intraoperative radiation therapy (IORT) codes used in breast cancer treatment: CPT 19294 (tumor cavity preparation with IORT applicator) and CPT 19297 (radiotherapy catheter placement for interstitial radiation). All ordering and servicing providers must obtain precertification before these procedures are performed.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Federal Employee Program Overpayment Recovery and Dispute Process Mandate
Effective January 1, 2027, Anthem Blue Cross and Blue Shield is implementing new overpayment recovery and dispute processes for the Federal Employee Program (FEP) in Georgia, mandated by the Office of Personnel Management (OPM). Providers will receive written notice of overpayments, which may be recovered through offsets against future payments; outstanding balances will be referred to collections after 180 days. Providers can now dispute overpayments by submitting written explanations and supporting documentation within 30 calendar days of receiving a dispute request.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] Administrative/Medical Policy Update (2/2)
CareSource Georgia Medicaid is revising two medical policies (Epidural Steroid Injection MM-0217 and Intraosseous Basivertebral Nerve Ablation MM-1303) and releasing a new administrative policy on Prior Authorization Submission for Providers (AD-1646), all effective January 1, 2027. The billing team must review the full revised policies online to identify specific coverage, coding, or prior authorization requirement changes and update workflows accordingly.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] Medical Policy Update
CareSource Georgia Medicaid is revising three medical policies effective January 1, 2027 and December 1, 2026. The notice lists policy updates but does not specify what changed within each policy. To understand billing and authorization requirements, your practice must access the full revised policies on CareSource.com.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] November 2026 Pharmacy Policy Updates (1/3)
CareSource Georgia Medicaid is introducing new pharmacy policies for seven drugs (adalimumab, brensocatib, donidalorsen, elamipretide, nerandomilast, imadenovec-drba, and remibrutinib) effective January 1, 2027. The notification does not specify coverage criteria, prior authorization requirements, or billing codes; the practice must access the full policies on CareSource's website to determine billing and authorization workflows for these new medications.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] New prior authorization requirements
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage in Georgia will require prior authorization for nine newly specified procedure and laboratory test codes, including oncology assays, ultrasound therapy, spinal procedures, and carotid device revisions. Billing teams must submit authorization requests through Availity Essentials before providing these services on or after the effective date to ensure timely claims processing and reimbursement.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] November 2026 Pharmacy Policy Updates (1/3)
CareSource Georgia Medicaid is establishing seven new pharmacy policies effective January 1, 2027, covering branded and generic medications including adalimumab (Humira and biosimilars), brensocatib, donidalorsen, elamipretide, nerandomilast, imadenovec-drba, and remibrutinib. Billing teams must verify coverage criteria, prior authorization requirements, and formulary status for these drugs before claims submission on or after the effective date.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] November 2026 Pharmacy Policy Updates
CareSource Georgia Medicaid is implementing seven new pharmacy policies effective January 1, 2027, covering medications including Adalimumab (Humira and biosimilars), Brinsupri, Dawnzera, Forzinity, Jascayd, Papzimeos, and Rhapsido. The billing team must prepare to apply these new policies to claims submitted on or after the effective date.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] November 2026 Pharmacy Policy Updates (2/3)
CareSource Georgia Medicaid is revising its pharmacy policy for Immune Globulin (IVIG and SCIG) effective January 1, 2027. The source document provides notice of this policy revision but does not specify what aspects of coverage, prior authorization, dosing, or reimbursement have changed. Billing teams must obtain and review the full revised policy before the effective date to determine workflow impacts.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] November 2026 Pharmacy Policy Updates (3/3)
CareSource Georgia Medicaid is revising pharmacy policies for 58 medications and drug classes effective January 1, 2027. The updates include revised coverage policies for existing medications (e.g., Aflibercept, Enbrel, Imbruvica), addition of three new medications (Exdensur, Hepcludex, Icotyde, Lynavoy, Waskyra), and an annual review of Pyrukynd. None of these policy changes impact prior authorization requirements.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] Administrative Policy Update (1/2)
CareSource Georgia is revising administrative policy AD-0084 regarding Electronic Data Interchange and Transactions, effective January 1, 2027. The full policy details are not provided in this notification document, only the policy title, number, and effective date are listed.
CareSource · Effective Jan 1, 2027Medium impact
[Georgia] Administrative Policy Update (2/2)
CareSource Georgia Medicaid is updating its Obstetrical Ultrasounds administrative policy (AD-1636) effective January 1, 2027. The notification announces this policy change but does not provide details of the specific content changes in the excerpt provided. The billing team must obtain the full policy document to identify what administrative requirements or workflows have been revised.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Precertification list change notification
Effective January 1, 2027, Anthem Blue Cross and Blue Shield (Georgia) is adding 7 new services to its precertification requirement list, including DME devices, gene therapy, prosthetics, and surgical procedures. Billing teams must obtain prior authorization for these services before rendering them to avoid reimbursement complications.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Updated Commercial provider manual available
Anthem Blue Cross and Blue Shield has released an updated 2027 Commercial Provider Manual for Georgia, effective January 1, 2027. The billing team must download and review this manual to identify any changes to billing policies, prior authorization requirements, covered services, or coding guidelines that may affect claims submission.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Precertification/prior authorization list change notification (October 2026 Newsletter)
Anthem Blue Cross and Blue Shield in Georgia changed its precertification and prior authorization list for commercial plans, effective January 1, 2027. The three notices in the October 2026 newsletter share that date, and the services on the list are in the linked article rather than in our copy.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Effective January 1, 2027, Anthem Blue Cross Blue Shield in Georgia is adding two codes to the precertification/prior authorization requirement list through Carelon Medical Benefits Management: CPT 64595 (revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver) and HCPCS Q4391 (Amnioplast double, per square centimeter). Prior authorization must be obtained before providing these services to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Prior authorization requirement changes
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will require prior authorization through Carelon Medical Benefits Management for two additional procedure codes: CPT 64595 (neurostimulator pulse generator revision/removal) and HCPCS Q4391 (amnioplast product). Providers must submit precertification requests via Carelon's provider portal, Availity, or email before delivering these services to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027Medium impact
[Georgia] Precertification/prior authorization list change notification
Anthem Blue Cross and Blue Shield in Georgia is adding two CPT codes (32664 and 64818) for surgical treatment of hyperhidrosis to their precertification/prior authorization requirements, effective January 1, 2027. Providers must obtain prior authorization before performing these procedures or claims will be denied.

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[Georgia] Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

[Georgia] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates

[Georgia] Include anatomical modifiers on outpatient facility claims

[Georgia] Review Excludes1 coding before submitting claims

[New York] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services

[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Georgia] Specialty pharmacy updates

[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Georgia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services

[Georgia] Claims Editing Enhancements

[Georgia] 2027 Medicare formulary changes: Prepare now for

[Georgia] National accounts: 2027 standard prior authorization requirements

[Georgia] Review clinically integrated network participation requirements

[Georgia] Reimbursement policy update: Maternity Services coding changes

[Georgia] National accounts: 2027 standard prior authorization requirements

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (October 2026 Newsletter)

New oncology prior authorization code updates

[Georgia] Specialty pharmacy updates

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

[Georgia] New reimbursement policy: Inpatient Hospital Inclusive Services — Facility

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Carelon Medical Benefits Management updates

[Georgia] Clinical Criteria updates

[Georgia] Administrative/Medical Policy Update (1/2)

[Georgia] Prior authorization required for MED.00164

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (September 2026 Newsletter)

[Georgia] Precertification/prior authorization list change notification

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Precertification/prior authorization list change notification

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Federal Employee Program Overpayment Recovery and Dispute Process Mandate

[Georgia] Administrative/Medical Policy Update (2/2)

[Georgia] Medical Policy Update

[Georgia] November 2026 Pharmacy Policy Updates (1/3)

[Georgia] New prior authorization requirements

[Georgia] November 2026 Pharmacy Policy Updates (1/3)

[Georgia] November 2026 Pharmacy Policy Updates

[Georgia] November 2026 Pharmacy Policy Updates (2/3)

[Georgia] November 2026 Pharmacy Policy Updates (3/3)

[Georgia] Administrative Policy Update (1/2)

[Georgia] Administrative Policy Update (2/2)

[Georgia] Precertification list change notification

[Georgia] Updated Commercial provider manual available

[Georgia] Precertification/prior authorization list change notification (October 2026 Newsletter)

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Prior authorization requirement changes

[Georgia] Precertification/prior authorization list change notification