Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement changes
Anthem BCBS·GA · Oncology, Pain Management, Urology +3 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 12, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage in Georgia is adding five new codes to their prior authorization/precertification requirement list: 0591U (prostate cancer biochemical analysis), 64624 (genicular nerve destruction), A4479 (electronic transanal irrigation system), A9294 (digital cognitive/behavioral therapy), and L2221 (microprocessor-controlled ankle orthosis). All claims for these services must obtain prior authorization before delivery or risk denial.
Action Required
By December 1, 2026: Billing team must update the prior authorization workflow in the billing system to flag these five codes (0591U, 64624, A4479, A9294, L2221) for Anthem Medicare Advantage Georgia members. Clinical staff and providers must be notified that precertification is required before service delivery for these codes. Update encounter forms and EMR templates to include reminders for prior auth submission through Availity or by phone to Anthem Provider Services. Claims submitted without prior authorization for these codes will be denied for Anthem Medicare Advantage members in Georgia. Establish appeals protocol using Availity or phone submission with supporting medical records when needed.