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[Georgia] Precertification/prior authorization requirement changes
Act
by Apr 30, 2026
Effective date
May 1, 2026
Identified
May 18, 2026
Summary
Effective May 1, 2026, Anthem Medicare Advantage in Georgia is adding prior authorization requirements for 12 specific billing codes related to bone strength/fracture risk analysis (CPT codes 0554T-0558T, G0130), cell therapies (J3402-J3403), and orthopedic devices (L1499, L5657). All services under these codes will require precertification before billing to Medicare Advantage members to avoid claim denials.
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What to do
by Apr 30, 2026 · 5 steps
01Billing team must update the billing system and prior authorization workflows to require precertification for CPT codes 0554T, 0555T, 0556T, 0557T, 0558T, G0130, J3402, J3403, L1499, and L5657 for all Anthem Medicare Advantage members in Georgia.
02Update encounter templates and billing software rules to flag these codes for mandatory Availity submission or phone-based prior authorization requests.
03Train providers and front desk staff to initiate prior authorization before scheduling or performing services.
04Claims submitted without prior authorization will be deemed ineligible for payment.
05For appeals or additional information, providers should contact Anthem using the number on the member ID card.
Codes mentioned
G0130J3402J3403L1499L5657
Original notice
[Georgia] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] Prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list