CommercialPrior AuthMedium impact
[New York] Important update on two‑stage compression device authorizations
Anthem BCBS·NY · Physical Therapy, Wound Care·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 12, 2026
Summary
Effective April 1, 2026, nine HCPCS codes for two-stage compression devices (E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, E0683) used in lymphedema treatment will require prior authorization under Anthem commercial plans in New York. This change aims to ensure medical necessity and reduce unnecessary high-cost device utilization. Patients with mastectomy combined with lymphedema diagnosis are exempt from this requirement.
Action Required
By March 31, 2026: Billing team must update billing system to require prior authorization for HCPCS codes E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, and E0683 when billing Anthem commercial plans in New York. Configure system to flag these codes for UM review before claim submission. Providers must document medical necessity and obtain prior authorization before dispensing two-stage compression devices, except for patients with both mastectomy and lymphedema diagnoses. Update encounter forms and clinical workflows to reflect authorization requirement. Claims submitted without prior authorization will be subject to denial.