Medicare AdvantagePrior AuthMedium impact
[New York] Precertification/prior authorization requirement changes
Anthem BCBS·NY · Oncology, Hematology, Transplant Surgery +4 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 12, 2026
Summary
Effective January 1, 2027, Anthem Medicare Advantage plans in New York will require prior authorization for 8 new procedure and supply codes, including prostate cancer screening (0591U), hematopoietic cell transplant preparation (38207-38209), genicular nerve destruction (64624), transanal irrigation systems (A4479), digital therapy (A9294), and lower extremity orthotic components (L2221). Billing teams must obtain precertification before providing these services to FIDE plan members or claims will be denied.
Action Required
By December 1, 2026: Billing and clinical teams must update internal systems and workflows to require prior authorization from Anthem before submitting claims for codes 0591U, 38207, 38208, 38209, 64624, A4479, A9294, and L2221 for all Fully Integrated Dual Eligible (FIDE) Medicare Advantage members in New York. Update encounter forms, billing software, and provider reminders to flag these codes for precertification. Train front-desk and billing staff to initiate prior auth requests through Availity Essentials or by calling Provider Services at 800-450-8753. Document all prior authorization requests and reference numbers before claim submission. Failure to obtain required prior authorization will result in claim denials and may render services ineligible for payment.