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[New York] Precertification/prior authorization list change notification
Act
by Dec 15, 2026
Effective date
Jan 1, 2027
Identified
Sep 4, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield in New York is adding 60 wound healing/soft tissue grafting product codes and 1 prostate cancer screening biomarker code to its precertification/prior authorization requirements. All services under these criteria must receive prior authorization before delivery to avoid claim denial.
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What to do
by Dec 15, 2026 · 7 steps
01Billing 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.
02Update encounter forms and provider templates to flag these codes as requiring precertification before service delivery.
03Train clinical and administrative staff on the new requirement.
04Establish 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.
05Verify member eligibility and benefit plan status at time of service.
06Any claims submitted without prior authorization approval will be denied for payment and may result in patient balance billing issues.
07Providers may appeal denials through Availity or by phone with supporting medical records and clinical justification.
Codes mentioned
A2036A2037A2038A2039A2040A2041A2042A2045Q4368Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382Q4383Q4384Q4385Q4386Q4387Q4388Q4389Q4390Q4392Q4393Q4394Q4395Q4396Q4397Q4398Q4399Q4400Q4401Q4402Q4403Q4404Q4405Q4406Q4407Q4408Q4409Q4411Q4412Q4413Q4414Q4415Q4416Q4417Q4418Q4419Q4420Q4421Q4422Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437Q4438Q4439Q4440
Original notice
[New York] Precertification/prior authorization list change notification
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Precertification/prior authorization requirement changesMediumEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Feb 1, 2027 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Feb 1, 2027 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementHighEffective Feb 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list
Related policy hubs
Anthem BCBS policiesNY policy changesGeneral SurgeryPlastic SurgeryWound CareOrthopedicsUrologyCode A2036Code A2037Code A2038Code A2039Code A2040Code A2041Code A2042Code A2045Code Q4368Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4382Code Q4383Code Q4384Code Q4385Code Q4386Code Q4387Code Q4388Code Q4389Code Q4390Code Q4392Code Q4393Code Q4394Code Q4395Code Q4396Code Q4397Code Q4398Code Q4399Code Q4400Code Q4401Code Q4402Code Q4403Code Q4404Code Q4405Code Q4406Code Q4407Code Q4408Code Q4409Code Q4411Code Q4412Code Q4413Code Q4414Code Q4415Code Q4416Code Q4417Code Q4418Code Q4419Code Q4420Code Q4421Code Q4422Code Q4423Code Q4424Code Q4425Code Q4426Code Q4427Code Q4428Code Q4429Code Q4435Code Q4436Code Q4437Code Q4438Code Q4439Code Q4440