CommercialPrior AuthMedium impact
[Ohio] Important update on two‑stage compression device authorizations
Anthem BCBS·OH · Physical Therapy, Wound Care, General Practice·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Blue Cross 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 commercial plans in Ohio. Patients with mastectomy combined with lymphedema diagnosis are exempt from the new prior authorization requirement.
Action Required
By March 31, 2026: Billing team must update billing software and prior authorization workflows to require prior authorization for HCPCS codes E0656, E0657, E0677, E0678, E0679, E0680, E0681, E0682, and E0683 when billed to Anthem Blue Cross Blue Shield commercial plans. Providers must document medical necessity for these compression device claims. Front desk and clinical staff should flag claims for patients with mastectomy AND lymphedema diagnosis to ensure they bypass the prior authorization requirement. Claims submitted without prior authorization (except for the mastectomy+lymphedema exception) will be denied by Anthem effective April 1, 2026.