CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization list change notification
Anthem BCBS·VA · Ophthalmology, Orthopedics, PM&R (Physical Medicine & Rehab) +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 Virginia is adding four new services to its precertification/prior authorization requirement list: PFAS testing (0589U), electrical stimulation devices (E0765), allogeneic bone marrow-derived mesenchymal stromal cell therapy (J3402), and encapsulated cell therapy for degenerative ocular disease (J3403). Providers must obtain prior authorization before delivering these services or claims may be denied for ineligibility.
Action Required
By April 1, 2026: Billing team must update billing software and prior authorization workflows to require precertification for CPT 0589U (PFAS testing), HCPCS E0765 (electrical stimulation devices), and HCPCS J3402 and J3403 (cell therapies). Providers and clinical staff must be notified to obtain prior authorization through Availity Essentials or by calling the member ID card number before rendering these services. Update encounter forms and pre-service checklists to flag these codes. Update provider education materials with new authorization requirements and contact information (800-755-0851 for mental health/substance use precertification). Failure to obtain required prior authorization will result in claim denials and service ineligibility.