CommercialPrior AuthHigh impact
[Georgia] Precertification/prior authorization list change notification
Anthem BCBS·GA · Hematology, Oncology, General Surgery +5 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 15, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (Georgia) is adding 24 new services to its precertification/prior authorization requirement list. These additions span four categories: advanced laboratory tests (4 codes), gene therapies (5 codes), hematopoietic stem cell transplantations (8 codes), and surgical procedures including irreversible electroporation and carotid sinus baroreceptor stimulation devices (7 codes). All services using these codes will require prior authorization before delivery to avoid claim denial.
Action Required
By October 15, 2026: Billing team must update billing software and clinical workflows to require prior authorization for all 17 affected CPT/HCPCS codes (0596U, 0598U, 0600U, 0609U, 38241, 47384, 55877, 64654-64659, 93145-93146, J3387, J3389) for Anthem Georgia Commercial members. Update encounter forms and provider templates to flag these services for mandatory prior auth submission via Availity Essentials before service delivery. Notify all clinical departments (oncology, hematology, surgery, laboratory) of new requirements. Staff must verify member eligibility and benefits at time of service through Availity or member ID card phone number. Failure to obtain prior authorization will result in claim denials and potential non-payment.