CommercialPrior AuthMedium impact
[Virginia] Prior authorization required for MED.00164
Anthem BCBS·VA · Hematology, Oncology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Sep 2, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Virginia now requires prior authorization for MED.00164 (Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome). Billing teams must obtain precertification before providing this service to ensure accurate reimbursement and avoid claim denials.
Action Required
Before December 1, 2026: Billing team and providers must implement prior authorization requirement for MED.00164 (Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome) in the Anthem Virginia Commercial plan. Update billing system workflows to flag this service code for precertification review. Verify member eligibility and benefits through Availity Essentials (https://Availity.com) before scheduling or providing services. Obtain precertification documentation before service delivery except in emergencies. Communicate this requirement to all providers who may order or deliver cellular immunotherapy. Claims submitted without prior authorization will be denied.