Medicare AdvantagePrior AuthHigh impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Oncology, Gastroenterology, General Surgery +5 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 6, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield will require prior authorization for 27 new procedure and supply codes for Medicare Advantage members in Virginia, including prostate cancer screening (0591U), skin graft procedures (1044T-1049T), esophageal procedures (43192, 43201, 43210, 43236, 43497), nerve destruction (64624), wound care matrices, neurostimulator devices, and orthotic devices. Claims submitted without prior authorization for these services will be denied.
Action Required
By December 31, 2026: Billing team must update all billing systems to require prior authorization through Anthem for the 31 affected codes (0591U, 1044T-1049T, 43192, 43201, 43210, 43236, 43497, 43999, 64624, A2036-A2045, A4479, A9294, C1826, C1827, G0682, G0684, L2221) for Medicare Advantage FIDE members in Virginia only. Update encounter forms and clinical templates to prompt providers to obtain precertification before scheduling or performing these procedures. Train front desk and clinical staff to verify prior authorization status at check-in. Establish workflow to submit authorization requests via Availity Essentials or phone (Provider Services). Effective January 1, 2027, do not bill these codes for Virginia Medicare Advantage members without documented prior authorization; claims will be denied and require appeal with supporting medical records. Post policy details from https://anthem.com/va/provider and https://Availity.com in billing area for reference.