Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Cardiology, Internal Medicine·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 21, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield will require prior authorization for CPT code 93356 (myocardial strain imaging using speckle tracking) for all Medicare Advantage members in Virginia, including FIDE, ISNP, and CSNP plans. Claims submitted without prior authorization may be denied.
Action Required
By October 31, 2026: Billing team must update the billing system and prior authorization workflows to require precertification for CPT 93356 when billing Anthem Medicare Advantage plans in Virginia. Update encounter templates and clinical decision support tools to prompt providers to obtain prior authorization before scheduling or performing myocardial strain imaging studies. Providers should access Anthem's precertification requirements via https://anthem.com/va/provider or Availity Essentials. Train front desk and authorization staff on the new requirement. Failure to obtain prior authorization will result in claim denials; appeals can be submitted through Availity Essentials or by phone to Provider Services.