Medicare AdvantagePrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement changes
Anthem BCBS·GA · Oncology, Pain Management, Gastroenterology +2 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 30, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Georgia will add prior authorization requirements for five specific codes: a prostate cancer biomarker test (0591U), genicular nerve destruction (64624), an electronic transanal irrigation system (A4479), prescription digital therapy (A9294), and a microprocessor-controlled ankle orthosis addition (L2221). Claims for these services will be denied if prior authorization is not obtained before service delivery.
Action Required
By December 31, 2026: Billing team must update billing system, EMR templates, and prior authorization workflows to require Anthem Medicare Advantage precertification for codes 0591U, 64624, A4479, A9294, and L2221 in Georgia. Providers must obtain prior authorization through Availity or by phone before delivering these services to Anthem Medicare Advantage members. Front desk staff should flag these codes during scheduling for Medicare Advantage patients. Failure to obtain prior authorization will result in claim denials and may require patient appeals. Update encounter forms to prompt providers to document medical necessity for these services.