CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization list change notification
Anthem BCBS·NY · Internal Medicine, Cardiology, Gastroenterology +6 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 (New York) is adding 13 new services to its precertification/prior authorization requirement list. These services span advanced laboratory testing (Alzheimer's biomarkers, IBS serology, infectious disease sequencing, prostate cancer screening), specialized surgical procedures (irreversible electroporation, carotid sinus baroreceptor stimulation), and gene therapies. All claims for these services must obtain prior authorization before delivery to avoid claim denial.
Action Required
By November 1, 2026: Billing team must update the billing system to flag all claims containing codes 0596U, 0598U, 0600U, 0609U, 47384, 55877, 64654-64659, 93145, 93146, J3387, and J3389 as requiring prior authorization before submission. Providers should be notified of the requirement change via a staff alert or EHR update. Front desk/scheduling staff must alert patients that these procedures require precertification. Verify member eligibility and benefits through Availity Essentials (https://Availity.com) or by calling the number on the back of member ID cards. Appeals of denials can be filed through Availity Essentials or by phone via Provider Services. Claims submitted without prior authorization will be denied for non-compliance.