Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · GA · Oncology, Physical Therapy, Neurosurgery +1 moreMedium impact

[Georgia] New prior authorization requirements

Effective date
Jan 1, 2027
Identified
Nov 1, 2026

Summary

Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage in Georgia will require prior authorization for nine newly specified procedure and laboratory test codes, including oncology assays, ultrasound therapy, spinal procedures, and carotid device revisions. Billing teams must submit authorization requests through Availity Essentials before providing these services on or after the effective date to ensure timely claims processing and reimbursement.

Get alerts when payers change rules like this one

We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.

Get Anthem BCBS alertsPolicy Monitoring is free. No card required.

What to do

Action · 4 steps
01Before January 1, 2027: Billing team must update prior authorization workflows in the practice management system and Availity Essentials to require precertification submission for the nine affected procedure and laboratory codes (81538, 81539, 0359U, 0312U, 97610, 0275T/62330/62331, C2614, 0271T/64659) for Anthem Blue Cross and Blue Shield Medicare Advantage members in Georgia.
02Providers should submit all authorization requests through Availity Essentials (https://Availity.com) before delivering these services.
03Failure to obtain required prior authorization may result in claim denials and delayed reimbursement.
04Refer to current Anthem utilization management guidelines and provider manual resources for any additional precertification requirements not listed in this notice.

Codes mentioned

8153881539976106233062331C261464659

Original notice

[Georgia] New prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.
View original ↗

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[California] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesGA policy changesOncologyPhysical TherapyNeurosurgeryVascular SurgeryCode 81538Code 81539Code 97610Code 62330Code 62331Code C2614Code 64659

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account