Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement changes
Anthem BCBS·GA · Orthopedics, Radiology, General Surgery +1 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
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.
Action Required
By April 30, 2026: Billing 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. Update encounter templates and billing software rules to flag these codes for mandatory Availity submission or phone-based prior authorization requests. Train providers and front desk staff to initiate prior authorization before scheduling or performing services. Claims submitted without prior authorization will be deemed ineligible for payment. For appeals or additional information, providers should contact Anthem using the number on the member ID card.