MedicaidPrior AuthMedium impact
[Virginia] Prior authorization requirement changes effective
Anthem BCBS·VA · Physical Therapy, Wound Care, Occupational Therapy +1 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 7, 2026
Summary
Effective April 1, 2026, HealthKeepers, Inc. (Anthem) is adding prior authorization requirements for 10 HCPCS codes related to pneumatic and non-pneumatic compression devices and garments for Virginia Medicaid members. Billing teams must update systems to require PA before submitting claims for these codes to avoid denials.
Action Required
By March 31, 2026: Billing team must update billing software and encounter templates to require prior authorization for HCPCS codes E0652, E0656, E0657, E0658, E0659, E0670, E0671, E0672, E0673, E0677, and E0683 for all Virginia Medicaid (HealthKeepers, Inc.) claims. Configure system to block claims submission without PA approval. Providers should submit PA requests via Availity Essentials (https://Availity.com), fax to 800-964-3627, or phone 800-901-0020. Failure to obtain prior authorization before claim submission will result in claim denials. Update internal workflows to ensure providers are notified of the new requirement.