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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Oncology, Rheumatology, Physical Therapy +3 moreMedium impact

[California] New prior authorization requirements

Effective date
Jan 1, 2027
Identified
Oct 31, 2026

Summary

Effective January 1, 2027, Anthem Blue Cross Medicare Advantage plans in California will require prior authorization for eight newly designated procedure and diagnostic codes, including oncology molecular tests, autoimmune diagnostics, ultrasound therapy, and spinal/vascular interventions. Billing teams must submit authorization requests through Availity before providing these services to avoid processing delays, though this change does not affect member benefits or cost-sharing.

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What to do

Action · 4 steps
01Before January 1, 2027: Billing and clinical staff must update internal utilization management workflows and billing system configurations to flag the following codes for mandatory prior authorization submission through Availity Essentials (https://Availity.com) before service delivery: 81538, 81539, 0359U, 0312U, 97610, 0275T/62330/62331, C2614, 0271T, and 64659.
02Providers should refer to current Anthem Blue Cross utilization management guidelines and provider manual resources for comprehensive prior authorization requirements.
03Claims submitted without required prior authorization on or after the effective date may experience processing delays.
04Authorization requests and appeals can be submitted through Availity.com or by contacting Anthem Provider Services.

Codes mentioned

8153881539976106233062331C261464659

Original notice

[California] New prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[New York] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[Ohio] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[Virginia] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[Georgia] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesCA policy changesOncologyRheumatologyPhysical TherapyNeurosurgeryVascular SurgeryPain ManagementCode 81538Code 81539Code 97610Code 62330Code 62331Code C2614Code 64659

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