CommercialPrior AuthMedium impact
[Virginia] Precertification list change notification
Anthem BCBS·VA · Cardiology, Cardiothoracic Surgery, Gastroenterology +3 more·Provider Bulletin
Effective date
Apr 15, 2026
We identified it
Aug 2, 2026
Summary
Anthem Blue Cross and Blue Shield Virginia is adding seven new services to its precertification (prior authorization) requirement list. Four services are effective immediately (4/15/2026), and three additional services become effective 11/1/2026. Failure to obtain precertification before rendering these services may result in claim denials and reimbursement complications.
Action Required
By April 15, 2026: Billing and clinical teams must immediately implement precertification requirements for CG-SURG-132 (Transendoscopic Therapy for GERD/Dysphagia/Gastroparesis) and CG-SURG-133 (Intraluminal Left Atrial Appendage Closure Devices) for all Anthem Virginia commercial patients. By November 1, 2026: Add ADMIN.00009 (Patient Safety), DME.00056 (Intrabuccal Amplitude-Modulated Radiofrequency Device for Cancer), MED.00149 (Gene Therapy for Leukocyte Adhesion Deficiency-I), MED.00165 (Gene Therapy for Hearing Loss), and MED.00166 (Mucosal Integrity Testing) to precertification workflows. Update billing software, encounter forms, and provider order entry systems to flag these services and route them for prior authorization before submission. Train front desk, clinical, and billing staff to verify Anthem Virginia coverage and obtain authorization through Availity Essentials or by calling the member's insurance card number. Communicate these requirements to all physicians and advanced practice providers who perform these procedures. Claims submitted without required precertification will be subject to denial or reimbursement complications.