Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · VA · Gastroenterology, Critical Care, General Surgery +4 moreMedium impact

[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listed

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
May 27, 2026

Summary

Effective July 1, 2026, Anthem will require prior authorization for 20 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) for Medicare Advantage members in Virginia. Prior authorization will be based on CMS LCD L38953 criteria, requiring documentation of a permanently nonfunctioning gastrointestinal tract. Claims submitted without prior authorization or that fail to meet medical necessity criteria will be denied.

Get alerts when payers change rules like this one

We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.

Get Anthem BCBS alertsPolicy Monitoring is free. No card required.

What to do

by Jun 30, 2026 · 5 steps
01Billing team must update billing system to require prior authorization for all 20 parenteral nutrition codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) when billing Anthem Medicare Advantage plans in Virginia.
02Clinical staff must ensure all parenteral nutrition claims include documentation of permanently nonfunctioning gastrointestinal tract per CMS LCD L38953 criteria.
03Configure billing system to prevent claim submission without prior authorization approval.
04Train providers and billing staff that claims submitted without prior authorization or failing to meet LCD criteria will be denied.
05Use Availity Essentials or contact Anthem Provider Services to submit prior authorization requests with supporting medical records.

Codes mentioned

B4164B4168B4172B4176B4178B4180B4185B4187B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listed
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[California] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization change to the parenteral nutrition codes listedHighEffective Jul 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesVA policy changesGastroenterologyCritical CareGeneral SurgeryInternal MedicineOncologyPediatricsPalliative CareCode B4164Code B4168Code B4172Code B4176Code B4178Code B4180Code B4185Code B4187Code B4189Code B4193Code B4197Code B4199Code B4216Code B4220Code B4222Code B4224Code B5000Code B5100Code B5200

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account