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 · NY · Gastroenterology, General Surgery, Critical Care +3 moreHigh impact

[New York] 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 Medicare Advantage plans in New York will require prior authorization for 20 parenteral nutrition-related HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200). Prior authorization must be obtained before dispensing to avoid claim denials. Services must meet CMS LCD L38953 criteria, requiring documentation of a permanently nonfunctioning gastrointestinal tract.

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 and clinical staff must implement prior authorization workflow for all 19 parenteral nutrition codes listed.
02Update billing system to flag and hold all B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, and B5200 claims for Anthem Medicare Advantage members until prior auth is obtained.
03Clinical staff must obtain prior authorization from Anthem before dispensing parenteral nutrition by submitting medical records documenting permanently nonfunctioning gastrointestinal tract per CMS LCD L38953 requirements.
04Billing team should reference detailed prior auth requirements on https://anthem.com/provider (Resources tab) or https://Availity.com for contracted providers.
05Train all relevant staff on new requirement and submission process via Availity Essentials or Provider Services contact.
If missed: Failure to obtain prior authorization will result in claim denials and delayed member access to medically necessary services.

Codes mentioned

B4164B4168B4172B4176B4178B4180B4185B4187B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

[New York] 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[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listedMediumEffective Jul 1, 2026 · Provider Bulletin[Virginia] 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 policiesNY policy changesGastroenterologyGeneral SurgeryCritical CareInternal MedicineNephrologyPalliative 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