Medicare AdvantagePrior AuthMedium impact
[California] Prior authorization requirement changes
Anthem BCBS·CA · Gastroenterology, Oncology·Provider Bulletin
Effective date
Mar 1, 2027
We identified it
Oct 20, 2026
Summary
Effective March 1, 2027, Anthem Blue Cross Medicare Advantage will require prior authorization for three newly added procedure codes: C9777 (esophageal mucosal integrity testing), E0767 (intrabuccal radiofrequency device for cancer treatment), and J3386 (etuvetidigene autotemcel injection). Billing team must update systems to route claims for these codes through precertification before submission to avoid payment denial.
Action Required
By March 1, 2027: Billing team must implement prior authorization requirements in the billing system for CPT/HCPCS codes C9777, E0767, and J3386 for all Anthem Blue Cross Medicare Advantage HMO plans in California. Update encounter forms, order entry systems, and claim submission workflows to require precertification submission via Availity Essentials or Provider Services (phone number on member ID card) before claim submission. Failure to obtain prior authorization may result in claim denial. Providers should reference https://anthem.com/ca/provider or https://Availity.com for detailed precertification requirements and contact Provider Services with questions.