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[Virginia] Precertification/prior authorization requirement changes
Effective date
Apr 1, 2026
Identified
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage (including FIDE plans) in Virginia is adding prior authorization requirements for 14 specific procedure and test codes, including respiratory pathogen testing, implantable hearing devices, cryolysis therapy, gait modulation systems, and atidarsagene autotemcel injection. Claims submitted without prior authorization for these codes will be denied.
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What to do
Action · 3 steps
01Before April 1, 2026: Billing team must update billing system and encounter forms to require prior authorization through Anthem for all Virginia Medicare Advantage members (including FIDE plans) for codes 0556U, 0563U, 0564U, 0951T, 0952T, 0953T, 0954T, 0955T, 0978T, 0979T, 0980T, E3200, and J3391.
02Configure system to flag these codes for mandatory prior auth submission via Availity Essentials or phone to Provider Services before claim submission.
03Provide staff training on new requirements.
If missed: Failure to obtain prior authorization will result in claim denials for Medicare Advantage members in Virginia.
Codes mentioned
E3200J3391
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 →[California] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] Prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list