CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Cardiology, Emergency Medicine, Internal Medicine·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 13, 2026
Summary
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.
Action Required
Before December 1, 2026: Billing and clinical teams must implement prior authorization workflow for CPT code K0606. (1) Update billing system configuration to flag K0606 claims for Anthem Georgia commercial plans requiring prior auth submission. (2) Ordering providers must submit precertification requests through Carelon Medical Benefits Management via their provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before dispensing the device. (3) Update internal ordering and servicing protocols to require prior auth documentation before device delivery. (4) Train front desk and clinical staff that K0606 orders cannot proceed without Carelon authorization. Consequence: Claims for K0606 submitted without prior authorization will be denied by Anthem.