CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Plastic Surgery, Wound Care, General Surgery +2 more·Provider Bulletin
Effective date
Feb 1, 2027
We identified it
Oct 7, 2026
Summary
Effective February 1, 2027, Anthem Blue Cross and Blue Shield will require precertification/prior authorization through Carelon Medical Benefits Management for 88 specific surgical codes related to skin grafts, skin substitutes, and neurostimulator generators across all Virginia HMO and PPO commercial plans. Billing teams must implement prior authorization workflows for these codes to avoid claim denials.
Action Required
Before February 1, 2027: Billing team must configure the practice's billing system and prior authorization workflows to require precertification through Carelon Medical Benefits Management for all 88 listed surgical codes (skin graft procedures, skin substitutes, and neurostimulator generators). Update internal provider guidelines and encounter documentation to flag these codes for prior authorization submission. Notify providers performing skin graft and neurostimulator implant procedures in Virginia of the new requirement. Failure to obtain prior authorization before February 1, 2027, will result in claim denials for Anthem Blue Cross and Blue Shield HMO and PPO commercial members in Virginia.