CommercialPrior AuthMedium impact
[Georgia] Important update on two‑stage compression device authorizations
Anthem BCBS·GA · Physical Therapy, Wound Care, General Surgery +1 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, nine HCPCS codes for two-stage compression devices (E0656, E0657, E0677-E0683) used in lymphedema treatment will require prior authorization for Anthem Blue Cross and Blue Shield Georgia commercial plans. This change aims to ensure medical necessity and reduce unnecessary high-cost device usage. Exception: Patients with mastectomy combined with lymphedema diagnosis are exempt from the prior authorization requirement.
Action Required
By March 31, 2026: Billing team must update billing software to require prior authorization for HCPCS codes E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, and E0683 when billed to Anthem Blue Cross and Blue Shield Georgia commercial plans. Update encounter forms and clinical staff documentation templates to capture diagnosis information, specifically flagging mastectomy + lymphedema cases for authorization exemption. Configure system to route claims with these codes to utilization management for UM review before submission. Train providers and front desk staff on the exception criteria. Claims submitted without prior authorization will be denied or subject to delay.