CommercialPrior AuthMedium impact
[Virginia] Important update on two‑stage compression device authorizations
Anthem BCBS·VA · Wound Care, Physical Therapy, Occupational Therapy·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Blue Cross and Blue Shield will require prior authorization for nine HCPCS codes (E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, E0683) associated with two-stage compression devices used to treat lymphedema. This change applies to Virginia commercial plans only, with an exception for patients with a combined mastectomy and lymphedema diagnosis.
Action Required
Before April 1, 2026: Billing team must update the practice management system and billing software to require prior authorization for HCPCS codes E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, and E0683 for all Virginia Anthem commercial plan members. Add a flag or workflow step to prevent claim submission without prior auth approval. Document the mastectomy + lymphedema exception in the system to bypass prior auth requirement for those cases. Notify all providers and front desk staff to request prior authorization before dispensing two-stage compression devices. Update billing templates and encounter forms with new prior auth requirements. Failure to obtain prior authorization will result in claim denials and potential patient financial liability.