CommercialPrior AuthMedium impact
[Virginia] VA precertification/prior authorization list change notification
Anthem BCBS·VA · General Practice·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
May 20, 2026
Summary
Effective June 1, 2026, Anthem Blue Cross and Blue Shield in Virginia is adding two durable medical equipment (DME) services to its prior authorization requirements: compression devices for lymphedema and pneumatic compression devices for deep vein thrombosis prevention in the home setting (HCPCS code E0650). Providers must obtain prior authorization before delivering these services or claims will be deemed ineligible for payment.
Action Required
By May 15, 2026: Billing team must update prior authorization workflows to require approval for HCPCS code E0650 (pneumatic compression devices for DVT prevention in home setting) and compression devices for lymphedema (criteria CG-DME-06, CG-DME-46). Update billing software and encounter forms to flag these codes for prior auth submission before claims are processed. Providers must submit prior authorization requests through Availity Essentials (https://Availity.com) or by phone to the member's plan (number on ID card). Claims submitted without prior authorization approval will be denied for non-compliance. Train all billing and clinical staff on the new requirement immediately.