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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Gastroenterology, General Surgery, Critical Care +2 moreMedium impact

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

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

Summary

Effective July 1, 2026, Anthem Blue Cross will require precertification/prior authorization for 20 parenteral nutrition 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 California. Claims lacking prior authorization or not meeting CMS LCD L38953 criteria (permanently nonfunctioning gastrointestinal tract) will be denied.

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What to do

by Jul 1, 2026 · 6 steps
01Billing team must update billing software to require prior authorization for all 19 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) for Anthem Medicare Advantage members in California only.
02Before submitting claims, obtain precertification through Availity Essentials by verifying the patient has a permanently nonfunctioning gastrointestinal tract per CMS LCD L38953.
03Update provider encounter forms and templates to prompt documentation of gastrointestinal tract status.
04Train billing staff and providers on new requirements.
05Communicate with ordering providers that claims without prior authorization or failing to meet medical necessity criteria will be denied.
06Use Availity Essentials or Provider Services (number on member ID card) for authorization requests and appeals.

Codes mentioned

B4164B4168B4172B4176B4178B4180B4185B4187B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

[California] 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 →
[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[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 policiesCA policy changesGastroenterologyGeneral SurgeryCritical CarePediatricsInternal MedicineCode B4164Code B4168Code B4172Code B4176Code B4178Code B4180Code B4185Code B4187Code B4189Code B4193Code B4197Code B4199Code B4216Code B4220Code B4222Code B4224Code B5000Code B5100Code B5200

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