CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization list change notification
Anthem BCBS·NY · Pain Management, Ophthalmology, PM&R (Physical Medicine & Rehab) +1 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 20, 2026
Summary
Effective May 1, 2026, Anthem Blue Cross and Blue Shield is adding four new services to its precertification/prior authorization requirements for New York 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 implement prior auth requirements for these codes before the effective date to avoid claim denials.
Action Required
Before May 1, 2026: Billing team must update the billing system and prior authorization workflows to require precertification for codes 0589U, E0765, J3402, and J3403 for all Anthem Blue Cross and Blue Shield commercial members in New York. Update encounter forms and provider reminders to flag these services for prior auth submission. Confirm Availity access is available for online prior auth submission or establish phone-based submission process via Provider Services. Train billing staff on the new requirements. Failure to obtain prior authorization before service delivery will result in claim denials and potential non-payment.