MedicaidPrior AuthMedium impact
[New York] Prior authorization requirement changes
Anthem BCBS·NY · Neurology, Pain Management, Oncology·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
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.
Action Required
By March 31, 2026: Billing team must update billing software and prior authorization protocols to require Anthem Medicaid precertification for CPT 64595, J3402, and J3403. Update all claim scrubbing rules, encounter forms, and provider reminders. Implement submission workflows using Availity Essentials (https://Availity.com), fax (800-964-3627), or phone (800-450-8753) for all claims with these codes. Educate providers and front desk staff that claims submitted without prior authorization for these codes will be denied. Establish process to monitor Anthem's detailed prior authorization requirements on https://anthembluecross.com/ny/provider (Resources tab).