Medicare AdvantagePrior AuthMedium impact
[Ohio] Prior authorization requirement changes
Anthem BCBS·OH · 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 specific medical codes (C9777, E0767, J3386) for Medicare Advantage members in Ohio. Claims submitted without prior authorization for these services may be denied. Providers must obtain precertification before delivering these services to Anthem MA members.
Action Required
By March 1, 2027: Billing and clinical staff should implement prior authorization requirements in the practice's billing system and provider workflows for codes C9777 (esophageal mucosal integrity testing), E0767 (intrabuccal radiofrequency device for cancer treatment), and J3386 (etuvetidigene autotemcel injection) when treating Anthem Medicare Advantage members in Ohio. Staff should verify these requirements through Anthem's provider portal (https://anthem.com/provider or https://Availity.com for contracted providers) or contact Anthem Provider Services via the member ID card for specific precertification procedures. Without prior authorization, these services may be deemed ineligible for payment and claims will be denied.