Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Oncology, Pain Management, Physical Therapy +1 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 Ohio is adding five new codes to its precertification/prior authorization requirements. Providers must obtain prior authorization before delivering services under codes 0591U, 64624, A4479, A9294, and L2221, or claims may be denied as ineligible for payment. This change applies only to Anthem Medicare Advantage members in Ohio.
Action Required
By December 31, 2026: Billing and clinical teams must update internal processes and billing software to flag and require prior authorization for codes 0591U, 64624, A4479, A9294, and L2221 for all Anthem Medicare Advantage members in Ohio. Add these codes to precertification workflow and encounter forms/order entry systems. Train providers and front-desk staff to initiate prior authorization requests through Availity or by phone (Provider Services number on member ID card) before scheduling or delivering these services. Failure to obtain precertification will result in claim denials and loss of payment eligibility. Establish internal tracking to monitor submission status and appeal any denials with medical records documentation through Availity or Provider Services.