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[Virginia] Prior authorization requirement changes
Effective date
Apr 1, 2026
Identified
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.
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What to do
Action · 3 steps
01Before 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.
02Providers must obtain prior authorization through Availity Essentials (https://Availity.com), fax (800-964-3627), or phone (800-901-0020) before submitting claims.
03Update encounter forms and provider communication to alert clinical staff of new prior auth requirements.
If missed: Failure to obtain prior authorization will result in claim denials and non-payment.
Codes mentioned
J3391
Original notice
[Virginia] Prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[California] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement changesMediumEffective Apr 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list