MedicaidPrior AuthMedium impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Cardiology, ENT (Ear, Nose & Throat), Oncology·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicaid in Virginia will require prior authorization for nine new procedure codes, including cardiac device interrogations (0948T, 0949T), totally implantable hearing implants (0951T-0955T), submucosal cryolysis therapy (0978T-0980T), and atidarsagene autotemcel injection (J3391). Claims submitted without prior authorization for these codes will be denied.
Action Required
Before April 1, 2026: Billing team must update the billing system to flag claims containing CPT codes 0948T, 0949T, 0951T, 0952T, 0953T, 0954T, 0955T, 0978T, 0979T, 0980T, and HCPCS code J3391 as requiring prior authorization for Anthem Medicaid Virginia members. Providers must obtain prior authorization through Availity Essentials (https://Availity.com), fax (800-964-3627), or phone (800-901-0020) before submitting claims. Update encounter forms and provider communication to alert clinical staff of new prior auth requirements. Failure to obtain prior authorization will result in claim denials and non-payment.