CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization list change notification
Anthem BCBS·GA · Pain Management, Ophthalmology, Oncology +2 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 18, 2026
Summary
Effective May 1, 2026, Anthem Blue Cross Blue Shield Georgia is adding four new services to its precertification/prior authorization requirement list for commercial plans: PFAS testing (0589U), electrical stimulation devices for pain (E0765), allogeneic bone marrow-derived mesenchymal stromal cell therapy (J3402), and encapsulated cell therapy for degenerative ocular disease (J3403). Billing teams must update systems to require prior authorization for these codes before claims are submitted.
Action Required
By April 15, 2026: Billing team must update the billing system and prior authorization workflow to require precertification/prior authorization for codes 0589U, E0765, J3402, and J3403 for all Anthem Blue Cross Blue Shield Georgia commercial plan members. Add these codes to the automated prior auth checking rules in the billing software. Update encounter forms and provider alerts to notify clinicians that these services require prior authorization before delivery. Verify member eligibility and benefits through Availity (https://availity.com) or by calling the member's insurance card number before scheduling or billing. Failure to obtain prior authorization before service delivery may result in claim denials and loss of reimbursement.