[New York] Precertification/prior authorization list change notification

By December 15, 2026: Billing team must update billing software and claim submission protocols to require prior authorization for all 61 affected codes (HCPCS codes A2036-A2045, Q4368-Q4440, and CPT code 0591U, 1044T-1049T) for Anthem BCBS commercial plans in New York. Update encounter forms and provider templates to flag these codes as requiring precertification before service delivery. Train clinical and administrative staff on the new requirement. Establish internal process to obtain prior authorization through Availity Essentials (https://Availity.com) or by calling the provider services number on member ID cards before billing. Verify member eligibility and benefit plan status at time of service. Any claims submitted without prior authorization approval will be denied for payment and may result in patient balance billing issues. Providers may appeal denials through Availity or by phone with supporting medical records and clinical justification.