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

[Ohio] 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 plans in Ohio will require prior authorization for eight new procedure and laboratory test codes, including oncology diagnostics, autoimmune testing, ultrasound therapy, and spinal/vascular procedures. Billing teams must submit authorization requests through Availity before providing these services to avoid potential claim delays.

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What to do

Action · 4 steps
01Before January 1, 2027: Billing team must implement prior authorization requirements in the practice's billing system and workflow for Anthem Medicare Advantage members in Ohio for the following codes: 81538, 81539, 0359U, 0312U, 97610, 0275T/62330/62331, C2614, 0271T/64659.
02Specifically, update claims submission procedures to require precertification/prior authorization requests submitted through Availity Essentials (https://Availity.com) before providing services on or after the effective date.
03Providers should refer to current Anthem utilization management guidelines and provider manual resources for comprehensive prior authorization requirements, as not all precertification requirements are reflected in this notice.
04Note: This change does not affect member benefits, coverage, or cost share.

Codes mentioned

8153881539976106233062331C261464659

Original notice

[Ohio] 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[Virginia] 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 policiesOH policy changesOncologyPhysical TherapyNeurosurgeryVascular SurgeryPain ManagementCode 81538Code 81539Code 97610Code 62330Code 62331Code C2614Code 64659

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