CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization list change notification
Anthem BCBS·NY · Dermatology, Neurosurgery, Orthopedics·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Jul 16, 2026
Summary
Anthem Blue Cross and Blue Shield is adding three services to its precertification/prior authorization requirements effective December 1, 2026: noninvasive imaging for skin lesion evaluation (CPT 1020T) and two percutaneous spinal surgery procedures (CPT 62330 and 62331). Prior authorization must be obtained before these services are performed to avoid claim denials.
Action Required
By November 30, 2026: Billing team must update the billing system and prior authorization workflows to require precertification for CPT codes 1020T, 62330, and 62331 for all Anthem Blue Cross and Blue Shield commercial members in New York. Providers must verify member eligibility and obtain prior authorization through Availity Essentials before scheduling or performing these services. Update encounter templates and clinical staff protocols to flag these codes for authorization requirements. Failure to obtain prior authorization will result in claim denials and may render services ineligible for payment.