Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement changes
Anthem BCBS·CA · Oncology, Pain Management, PM&R (Physical Medicine & Rehab) +2 more·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 14, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross Medicare Advantage (DSNP) plans in California will require prior authorization for six new service codes: prostate cancer screening (0591U), genicular nerve destruction (64624), electronic transanal irrigation system (A4479), digital cognitive therapy (A9294), microprocessor-controlled ankle orthosis (L2221), and cord blood harvesting (S2140). Claims submitted without prior authorization may be denied.
Action Required
By November 1, 2026: Billing team must update prior authorization workflows in billing software and Availity portal to require precertification for CPT 0591U, 64624, A4479, A9294, L2221, and S2140 for Anthem Blue Cross Medicare Advantage DSNP members in California only. Add these codes to encounter forms and internal checklists. Provider Services must be trained on new requirements. Clinical staff should document medical necessity in patient records, as claims submitted without prior authorization will be denied and may require appeal submission with medical records through Availity Essentials or phone (contact information on member ID card).