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[Virginia] Precertification/prior authorization requirement changes
Effective date
Mar 1, 2027
Identified
Nov 3, 2026
Previous versions
- [Virginia] Precertification/prior authorization requirement changes · effective Mar 1, 2027
Summary
Effective March 1, 2027, Anthem Blue Cross and Blue Shield will require prior authorization for 16 specific CPT and HCPCS codes related to urological procedures, autonomic nervous system testing, and other services for Medicare Advantage members in Virginia. Claims submitted without prior authorization for these codes will be denied.
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What to do
Action · 6 steps
01Before March 1, 2027.
02Billing team: Update charge entry and prior authorization tracking systems to flag CPT codes 0596T, 0597T, 51715, 53445, 53446, 53447, 53448, 53449, 53452, 95921, 95922, 95923, 95924, and HCPCS codes C1815, C9777, E0767, J3386 as requiring prior authorization for Anthem Medicare Advantage FIDE plan members in Virginia.
03Front desk and scheduling staff: Stop scheduling these procedures without obtaining prior authorization first.
04Providers and billing team: Establish a workflow to submit prior authorization requests through Anthem's Availity Essentials portal or by phone to Provider Services before the service date.
05Billing team: Ensure no claims for these codes are submitted without documented prior authorization approval, as claims without it will be denied.
06Billing team: Watch for Anthem's detailed precertification/prior authorization requirements on https://anthem.com/va/provider or through Availity.com for contracted providers, and update internal policies accordingly.
Codes mentioned
5171553445534465344753448534495345295921959229592395924C1815C9777E0767J3386
Original notice
[Virginia] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[Virginia] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[California] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[California] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list