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Anthem BCBSCommercial · Prior Auth · Provider Bulletin · NY · Pain Management, Ophthalmology, PM&R (Physical Medicine & Rehab) +1 moreMedium impact

[New York] Precertification/prior authorization list change notification

Effective date
May 1, 2026
Identified
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.

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What to do

Action · 4 steps
01Before 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.
02Update encounter forms and provider reminders to flag these services for prior auth submission.
03Confirm Availity access is available for online prior auth submission or establish phone-based submission process via Provider Services.
04Train billing staff on the new requirements.
If missed: Failure to obtain prior authorization before service delivery will result in claim denials and potential non-payment.

Codes mentioned

E0765J3402J3403

Original notice

[New York] Precertification/prior authorization list change notification
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Virginia] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization list change notificationMediumEffective May 1, 2026 · Provider Bulletin[California] Prior authorization requirement changesMediumEffective May 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization requirement changesMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesPain ManagementOphthalmologyPM&R (Physical Medicine & Rehab)OncologyCode E0765Code J3402Code J3403

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