Medicare AdvantagePrior AuthHigh impact
[California] Precertification/prior authorization requirement changes
Anthem BCBS·CA · Oncology, Plastic Surgery, Gastroenterology +4 more·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 6, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross Medicare Advantage (ISNP and CSNP plans) in California is adding 32 new codes to their prior authorization requirement list, spanning oncology testing, advanced skin grafting procedures, esophageal/gastric interventions, pain management, wound care products, and orthotic devices. All claims for these services submitted without prior authorization will be deemed ineligible for payment.
Action Required
By November 1, 2026: Billing team must update all billing system workflows and EMR templates to require prior authorization from Anthem before submitting claims for the 31 affected CPT/HCPCS codes (0591U, 1044T-1049T, 43192, 43201, 43210, 43236, 43497, 43999, 64624, A2036-A2045, A4479, A9294, C1826, C1827, G0682, G0684, L2221) for Medicare Advantage members in California. Verify patient plan type and member eligibility before submitting; ensure all prior authorization requests are submitted through Availity Essentials or by calling Anthem Provider Services. Update provider encounter forms and clinical staff protocols to notify providers of the new prior auth requirements for these procedures. Claims submitted without required prior authorization will be denied and deemed ineligible for payment. Establish internal tracking to ensure all affected procedures are routed through prior auth workflows before claim submission.