Medicare AdvantagePrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Infectious Disease, Audiology, ENT (Ear, Nose & Throat) +3 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
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.
Action Required
Before 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. Configure system to flag these codes for mandatory prior auth submission via Availity Essentials or phone to Provider Services before claim submission. Provide staff training on new requirements. Failure to obtain prior authorization will result in claim denials for Medicare Advantage members in Virginia.