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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · VA · Oncology, Radiology, Physical Therapy +2 moreMedium impact

[Virginia] New prior authorization requirements

Effective date
Jan 1, 2027
Identified
Nov 1, 2026

Summary

Effective January 1, 2027, Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. (Medicare Advantage) in Virginia will require prior authorization for eight newly specified procedure and test codes, including oncology assays, diagnostic imaging, ultrasound therapy, and spinal procedures. Billing teams must submit authorization requests through Availity before providing these services to avoid claims processing delays.

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What to do

Action · 5 steps
01Before January 1, 2027: Billing team must update internal prior authorization protocols and billing system workflows to require precertification submission through Availity Essentials (https://Availity.com) for all claims involving codes 81538, 81539, 0359U, 0312U, 97610, 0275T/62330/62331, C2614, 0271T, and 64659.
02Providers must submit authorization requests before delivering these services on or after the effective date to support timely claims processing and reimbursement.
03Verify that practice management and eligibility systems flag these codes for Anthem Medicare Advantage members in Virginia and route them for prior auth review.
04Note: This change does not affect member benefits, coverage, or cost-share; medically necessary testing and procedures will not be affected.
05Retain current utilization management guidelines for comprehensive prior authorization requirements beyond this notice.

Codes mentioned

8153881539976106233062331C261464659

Original notice

[Virginia] 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[Georgia] 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 policiesVA policy changesOncologyRadiologyPhysical TherapyNeurosurgeryCardiologyCode 81538Code 81539Code 97610Code 62330Code 62331Code C2614Code 64659

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