CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization list change notification
Anthem BCBS·VA · Cardiology, Urology, Vascular Surgery +5 more·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Jul 10, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Virginia is adding 14 new services to its precertification/prior authorization requirement list. These include four advanced laboratory tests (Alzheimer's biomarkers, IBS serology, infectious disease sequencing, and prostate cancer protein biomarkers), two irreversible electroporation procedures, six carotid sinus baroreceptor stimulation device codes, and two gene therapy treatments. All services require prior authorization before delivery or claims may be denied.
Action Required
By November 1, 2026: Billing team must update the billing system to flag all 16 affected codes for mandatory prior authorization submission to Anthem before service delivery. Update encounter forms and provider templates to include these codes as requiring precertification. Communicate requirements to all clinical staff ordering these services—specifically laboratory personnel, cardiologists, vascular surgeons, urologists, and geneticists. Verify member eligibility and benefits through Availity Essentials before scheduling. Document that failure to obtain prior authorization will result in claim denials. Establish internal audit process to track compliance with the new requirement starting December 1, 2026.