CommercialPrior AuthMedium impact
[New York] Precertification/prior authorization list change notification
Anthem BCBS·NY · Wound Care, Physical Therapy, Occupational Therapy·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 14, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield (New York) is adding compression devices for lymphedema (HCPCS code E0659) to its precertification/prior authorization requirements. Billing teams must obtain prior authorization before submitting claims for this service or face potential claim denials.
Action Required
By November 15, 2026: Billing team must update the billing system to require prior authorization for HCPCS code E0659 (Compression devices for lymphedema) under Anthem Blue Cross and Blue Shield commercial plans in New York. Update encounter forms and clinical workflows to ensure providers request prior authorization before ordering or billing for compression devices. Implement verification process using Availity Essentials (https://Availity.com) or Provider Services to confirm member eligibility and obtain authorization. Staff should reference criteria CG-DME-06 when submitting authorization requests. Claims submitted without prior authorization for E0659 will be denied effective December 1, 2026.