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

[New York] New prior authorization requirements

Effective date
Jan 1, 2027
Identified
Nov 1, 2026

Summary

Effective January 1, 2027, Anthem Medicare Advantage plans in New York will require prior authorization for nine specific procedure and diagnostic test codes, including oncology assays, ultrasound therapy, and spinal/carotid procedures. Providers must submit precertification requests through Availity Essentials before service delivery to avoid claims processing delays.

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What to do

Action · 5 steps
01Before January 1, 2027: Billing team and clinical staff must implement prior authorization requirements for the nine listed codes (81538, 81539, 0359U, 0312U, 97610, 0275T/62330/62331, C2614, 0271T/64659) in the billing system and encounter workflows for Anthem Medicare Advantage members in New York.
02Establish a process to submit precertification requests through Availity Essentials (https://Availity.com) prior to service delivery.
03Update provider and front desk staff on the new requirement.
04Note: This change does not affect member benefits or cost-sharing, and medically necessary services will not be denied; however, claims submitted without prior authorization may experience processing delays.
05Refer to current utilization management guidelines for comprehensive prior authorization requirements, as this notice does not reflect all precertification obligations.

Codes mentioned

8153881539976106233062331C261464659

Original notice

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

Related policy hubs

Anthem BCBS policiesNY policy changesOncologyPhysical TherapyNeurosurgeryCardiologyVascular SurgeryCode 81538Code 81539Code 97610Code 62330Code 62331Code C2614Code 64659

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