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 will require prior authorization for 16 specific procedure and diagnostic codes related to urinary continence devices, autonomic nervous system testing, and select other procedures for Medicare Advantage members in California. Claims submitted without required prior authorization may be denied for payment.
Action Required
By March 1, 2027: Billing team must implement prior authorization requirements in the billing system for all 17 affected codes (0596T, 0597T, 51715, 53445, 53446, 53447, 53448, 53449, 53452, 95921, 95922, 95923, 95924, C1815, C9777, E0767, J3386) when processing claims for Anthem Blue Cross Medicare Advantage members in California, including C-SNP and I-SNP plans. Prior to submitting claims for these procedures, providers must obtain precertification through Availity Essentials or by calling the Provider Services number on the member ID card. Failure to obtain required prior authorization may result in claim denial and loss of payment.