Medicare AdvantagePrior AuthMedium impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Gastroenterology, Oncology·Provider Bulletin
Effective date
Mar 1, 2027
We identified it
Oct 20, 2026
Summary
Effective March 1, 2027, Anthem Blue Cross and Blue Shield will add prior authorization requirements for three new medical codes (C9777, E0767, J3386) for Medicare Advantage members in Virginia. Claims for these services submitted without prior authorization may be denied. Providers must obtain precertification before delivering these services.
Action Required
By March 1, 2027: Billing team and clinical staff must implement prior authorization requirements for codes C9777 (esophageal mucosal integrity testing), E0767 (intrabuccal radiofrequency device for cancer treatment), and J3386 (etuvetidigene autotemcel injection) for Anthem Medicare Advantage members in Virginia. Update billing system workflows to require and document precertification before claim submission. Train providers to obtain prior authorization through Availity Essentials or by calling Provider Services (number on member ID card) before delivering these services. Failure to obtain prior authorization may result in claim denial and service being deemed ineligible for payment.