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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Orthopedics, Neurosurgery, PM&R (Physical Medicine & Rehab) +1 moreMedium impact

[California] Prior authorization requirement changes

Act
by Apr 1, 2026
Effective date
May 1, 2026
Identified
May 18, 2026

Summary

Effective May 1, 2026, Anthem Medicare Advantage plans in California will require prior authorization for 11 new billing codes related to bone strength analysis, neurostimulator procedures, spinal orthoses, and lower extremity prosthetics. Billing teams must update their systems to request precertification before submitting claims for these services to Medicare Advantage members, or claims will be denied.

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What to do

by Apr 1, 2026 · 3 steps
01Billing team must update billing software and encounter forms to require prior authorization from Anthem before submitting claims for CPT codes 0554T, 0555T, 0556T, 0557T, 0558T, 0743T, 64595, and HCPCS codes G0130, J3402, J3403, L1499, L5657 for all Anthem Medicare Advantage (HMO, C-SNP, I-SNP) members in California.
02Configure system to flag these codes for precertification requirement and route requests through Availity Essentials or Provider Services.
03Train billing and clinical staff on new requirements.
If missed: Failure to obtain prior authorization will result in claim denials and member liability.

Codes mentioned

64595G0130J3402J3403L1499L5657

Original notice

[California] Prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Georgia] Precertification/prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[New York] Prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] March 2026 Provider NewsletterMediumEffective Apr 1, 2026 · Newsletter[New York] March 2026 Provider NewsletterHighEffective Apr 1, 2026 · NewsletterBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesCA policy changesOrthopedicsNeurosurgeryPM&R (Physical Medicine & Rehab)GeriatricsCode 64595Code G0130Code J3402Code J3403Code L1499Code L5657

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