CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization list change notification
Anthem BCBS·VA · Ophthalmology, Optometry, Pediatrics·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 10, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield (Virginia) is adding Dichoptic Digital Therapy for Amblyopia (CPT codes 0687T, 0688T, 0704T, 0705T, 0706T, and HCPCS A9292) to its precertification/prior authorization requirements. Providers must obtain prior authorization before rendering these services or claims may be denied as ineligible for payment.
Action Required
By December 31, 2026: Billing team must update the billing system to flag CPT codes 0687T, 0688T, 0704T, 0705T, 0706T, and HCPCS code A9292 as requiring prior authorization for all Anthem Blue Cross and Blue Shield Virginia commercial plans (HMO, PPO, and EPO). Update encounter forms and provider workflows to ensure the ordering or rendering provider obtains precertification through Availity Essentials (https://Availity.com) or by calling the number on the member's ID card before service delivery. Beginning January 1, 2027, all claims for these codes submitted without prior authorization will be deemed ineligible for payment and will be denied.