Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Urology, Neurology·Provider Bulletin
Effective date
Mar 1, 2027
We identified it
Oct 16, 2026
Summary
Effective March 1, 2027, Anthem Blue Cross and Blue Shield will require prior authorization for 17 specific CPT, HCPCS, and temporary codes related to urological procedures, autonomic nervous system testing, and specialized devices for Medicare Advantage members in Virginia. Services billed without prior authorization may be deemed ineligible for payment.
Action Required
By March 1, 2027: Billing team must implement prior authorization requirements in the billing system for the 17 affected codes (0596T, 0597T, 51715, 53445–53449, 53452, 95921–95924, C1815, C9777, E0767, J3386) for all Anthem Medicare Advantage members in Virginia, including C-SNP and I-SNP plans. Providers must obtain prior authorization before billing these services through Availity Essentials or by contacting Anthem Provider Services. Claims submitted without required prior authorization will be denied. Verify current applicability on https://anthem.com/provider or https://Availity.com for the most current precertification requirements.