Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement changes
Anthem BCBS·CA · Oncology, Pain Management, Gastroenterology +2 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 12, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross Medicare Advantage PPO plans in California will require prior authorization for five new procedure and supply codes: prostate cancer biochemical testing (0591U), genicular nerve destruction (64624), electronic transanal irrigation systems (A4479), digital cognitive therapy (A9294), and microprocessor-controlled ankle orthosis additions (L2221). Claims submitted without prior authorization may be denied as ineligible for payment.
Action Required
By December 31, 2026: Billing team and clinical staff must update billing system and workflow processes to require prior authorization from Anthem before submitting claims for codes 0591U, 64624, A4479, A9294, and L2221 for all Medicare Advantage PPO members in California. Update encounter forms, templates, and pre-service verification checklists to flag these codes for prior auth review. Train front desk and billing staff to request prior authorization through Availity or by contacting Anthem Provider Services before services are rendered. Failure to obtain prior authorization will result in claim denials and potential member billing issues. Post-service appeals are available through Availity or phone with supporting documentation.