Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement changes
Anthem BCBS·CA · Urology, Neurology, Gastroenterology +1 more·Provider Bulletin
Effective date
Mar 1, 2027
We identified it
Oct 14, 2026
Summary
Effective March 1, 2027, Anthem Blue Cross Medicare Advantage will require prior authorization for 16 specific procedure codes related to urological sphincter devices, autonomic nervous system testing, and select other procedures. Billing teams must update their prior authorization workflows to require pre-certification for these codes before claim submission to avoid payment denials.
Action Required
By March 1, 2027: Billing team must update the prior authorization requirement matrix in the billing system to flag the 16 affected codes (0596T, 0597T, 51715, 53445, 53446, 53447, 53448, 53449, 53452, 95921, 95922, 95923, 95924, C1815, C9777, E0767, J3386) for Anthem Blue Cross Medicare Advantage HMO members in California. Ensure all affected codes require precertification submission via Availity Essentials or Provider Services contact before claim processing. Train clinical and billing staff that claims for these codes submitted without prior authorization may be denied as ineligible for payment. Providers may appeal denials with additional medical records through Availity or by phone.