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Anthem BCBSMedicaid · Prior Auth · Provider Bulletin · NY · Neurology, Pain Management, OncologyMedium impact

[New York] Prior authorization requirement changes

Act
by Mar 31, 2026
Effective date
Apr 1, 2026
Identified
May 8, 2026

Summary

Effective April 1, 2026, Anthem Medicaid in New York will require prior authorization for three new procedure/drug codes: CPT 64595 (neurostimulator pulse generator revision/removal), HCPCS J3402 (remestemcel-l-rknd injection), and HCPCS J3403 (revakinagene taroretcel-lwey implant). Billing teams must implement prior authorization workflows for these codes before the effective date to avoid claim denials.

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What to do

by Mar 31, 2026 · 5 steps
01Billing team must update billing software and prior authorization protocols to require Anthem Medicaid precertification for CPT 64595, J3402, and J3403.
02Update all claim scrubbing rules, encounter forms, and provider reminders.
03Implement submission workflows using Availity Essentials (https://Availity.com), fax (800-964-3627), or phone (800-450-8753) for all claims with these codes.
04Educate providers and front desk staff that claims submitted without prior authorization for these codes will be denied.
05Establish process to monitor Anthem's detailed prior authorization requirements on https://anthembluecross.com/ny/provider (Resources tab).

Codes mentioned

64595J3402J3403

Original notice

[New York] Prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[California] Prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[Virginia] March 2026 Provider NewsletterMediumEffective Apr 1, 2026 · Newsletter[New York] March 2026 Provider NewsletterHighEffective Apr 1, 2026 · Newsletter[New York] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesNeurologyPain ManagementOncologyCode 64595Code J3402Code J3403

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