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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Gastroenterology, OncologyMedium impact

[California] Precertification/prior authorization requirement changes

Effective date
Mar 1, 2027
Identified
Nov 3, 2026

Previous versions

Summary

Effective March 1, 2027, Anthem Blue Cross Medicare Advantage will require prior authorization for three new procedures: esophageal mucosal integrity testing (C9777), intrabuccal radiofrequency electromagnetic field device for cancer treatment (E0767), and etuvetidigene autotemcel injection (J3386). The practice must obtain prior authorization before scheduling these services for affected D-SNP members, or claims will be denied.

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What to do

Action · 7 steps
01Before March 1, 2027.
02Billing team: Update charge entry and prior authorization tracking to flag C9777, E0767, and J3386 for all Anthem Blue Cross Dual Special Needs Plans (D-SNPs) in California and ensure these codes require prior authorization submission before claims are sent.
03Front desk and scheduling staff: Stop scheduling these procedures for D-SNP members without first obtaining prior authorization from Anthem.
04Providers and billing staff: Get prior authorization through Availity Essentials or by calling Provider Services (number on member ID card) before any of these services are performed for D-SNP members.
05Document the prior authorization approval number in the patient's chart and on the claim.
06Without prior authorization, claims for these codes will be denied for D-SNP members.
07If prior authorization is denied, providers may appeal online through Availity Essentials or by phone with additional medical records.

Codes mentioned

C9777E0767J3386

Original notice

[California] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[New York] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[Ohio] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[Virginia] Precertification/prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider Bulletin[California] Prior authorization requirement changesMediumEffective Mar 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesCA policy changesGastroenterologyOncologyCode C9777Code E0767Code J3386

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