CommercialPrior AuthMedium impact
[Virginia] Coverage Guidelines updates, effective
Anthem BCBS·VA · ENT (Ear, Nose & Throat), Audiology, Neurology +3 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Aug 2, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and HealthKeepers, Inc. in Virginia are implementing revised coverage guidelines for three procedures/services: Cochlear Implants and Auditory Brainstem Implants (CG-SURG-81), Testing for Biochemical Markers for Alzheimer's Disease (LAB.00046), and Gene Therapy for Beta Thalassemia (MED.00140). These services will now require prior authorization for most commercial products (exceptions: Anthem HealthKeepers Plus, Medicare Advantage, and FEP). Billing teams must update systems to enforce prior authorization requirements for these three guideline codes.
Action Required
By October 31, 2026: Billing and clinical teams must implement prior authorization requirements for the following Anthem guideline codes: CG-SURG-81 (Cochlear Implants and Auditory Brainstem Implants), LAB.00046 (Testing for Biochemical Markers for Alzheimer's Disease), and MED.00140 (Gene Therapy for Beta Thalassemia). Update billing software and provider submission workflows to flag these services for mandatory prior authorization on commercial plans, excluding HealthKeepers Plus, Medicare Advantage, and FEP products. Notify all providers and surgery/procedure scheduling staff. Pre-determinations can be requested for PPO products. Failure to obtain prior authorization will result in claim denials. Reference Anthem's website (www.anthem.com) for full guideline details.