Medicare AdvantagePrior AuthMedium impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Neurosurgery, Pain Management·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 19, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield and HealthKeepers in Virginia are adding two codes to their prior authorization requirements: CPT 64595 (neurostimulator pulse generator revision/removal) and HCPCS Q4391 (amnioplast double). All services using these codes will require precertification through Carelon Medical Benefits Management before delivery of service.
Action Required
By December 31, 2026: Billing team must update billing system and encounter forms to flag CPT 64595 and HCPCS Q4391 as requiring prior authorization for Anthem Blue Cross and Blue Shield and HealthKeepers Virginia Medicare Advantage plans. Providers must submit precertification requests via Carelon Medical Benefits Management provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before scheduling or performing these services. Claims submitted without prior authorization will be subject to denial.