CommercialPrior AuthMedium impact
[Georgia] Prior authorization required for MED.00164
Anthem BCBS·GA · Oncology, Hematology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Sep 2, 2026
Summary
Anthem Blue Cross and Blue Shield (Georgia) is adding MED.00164 (Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome) to its precertification requirements, effective December 1, 2026. Prior authorization must be obtained before providing this service to ensure accurate reimbursement and avoid claim denials.
Action Required
By November 15, 2026: Billing team must update internal workflows and billing system to require prior authorization for MED.00164 (Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome). Providers must obtain precertification through Availity Essentials (https://Availity.com) or by calling the member's insurance card phone number BEFORE providing the service. Update encounter forms and clinical staff communication to alert providers of this new precertification requirement. Verify member eligibility and covered benefits at time of service, as benefit plans vary by contract. Failure to obtain prior authorization will result in claim denials.