Medicare AdvantagePrior AuthMedium impact
[New York] Prior authorization requirement changes
Anthem BCBS·NY · Neurosurgery, Pain Management, OB-GYN·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 19, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in New York will require prior authorization/precertification for two additional procedures: CPT 64595 (revision/removal of neurostimulator pulse generator) and HCPCS Q4391 (Amnioplast double). All prior authorization requests must be submitted to Carelon Medical Benefits Management via their provider portal or Availity.
Action Required
By December 31, 2026: Billing team and providers must implement prior authorization requirement for CPT 64595 and HCPCS Q4391 for Anthem Medicare Advantage members in New York. Update billing system and encounter forms to flag these codes for mandatory precertification through Carelon Medical Benefits Management before service delivery. Establish workflow to submit prior auth requests via Carelon's provider portal (https://providerportal.com) or Availity (https://Availity.com). Train ordering and servicing providers on new requirement. Claims submitted without prior authorization will be subject to denial per Anthem's standard policy.