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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · CA · Infectious Disease, Audiology, ENT (Ear, Nose & Throat) +2 moreMedium impact

[California] Precertification/prior authorization requirement changes

Act
by Mar 31, 2026
Effective date
Apr 1, 2026
Identified
May 3, 2026

Summary

Effective April 1, 2026, Anthem Medicare Advantage plans in California will require prior authorization for 13 newly designated procedures and tests, including respiratory pathogen panels (CPT 0556U, 0563U, 0564U), totally implantable hearing implants (CPT 0951T-0955T), submucosal cryolysis therapy (CPT 0978T-0980T), gait modulation systems (HCPCS E3200), and atidarsagene autotemcel injection (HCPCS J3391). Claims submitted without prior authorization for these codes will be denied.

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What to do

by Mar 31, 2026 · 4 steps
01Billing team must update billing system and prior authorization workflows to require pre-approval from Anthem for all 13 affected codes when billing Medicare Advantage DSNP members in California.
02Update encounter forms and provider order entry templates to include alerts for codes 0556U, 0563U, 0564U, 0951T, 0952T, 0953T, 0954T, 0955T, 0978T, 0979T, 0980T, E3200, and J3391.
03Train providers and front desk staff to initiate prior authorization requests through Availity Essentials or by phone (number on member ID card) before services are rendered.
04Establish internal process to track and monitor prior auth status for these codes.
If missed: Failure to obtain prior authorization will result in claim denials and potential patient balance liability.

Codes mentioned

E3200J3391

Original notice

[California] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Virginia] 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

Related policy hubs

Anthem BCBS policiesCA policy changesInfectious DiseaseAudiologyENT (Ear, Nose & Throat)Sleep MedicinePhysical TherapyCode E3200Code J3391

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