Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Oncology, Pain Management, Orthopedics +2 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 plans in Virginia will require prior authorization for five new service codes: prostate cancer biochemical testing (0591U), genicular nerve destruction (64624), electronic transanal irrigation system (A4479), digital cognitive therapy (A9294), and microprocessor-controlled ankle orthosis (L2221). Claims submitted without prior authorization may be denied as ineligible for payment.
Action Required
By December 15, 2026: Billing team must update the prior authorization workflow in the billing system to require precertification for CPT 0591U, 64624, A4479, A9294, and L2221 for all Anthem Medicare Advantage members in Virginia. Update encounter forms and provider templates to include reminders that prior authorization must be obtained before service delivery. Train front desk and clinical staff to verify prior authorization status before scheduling or performing these services. Beginning January 1, 2027, do not bill these codes without documented prior authorization approval from Anthem, or claims will be denied as ineligible for payment. Providers may appeal denials through Availity portal or by calling Anthem Provider Services.