MedicaidPrior AuthMedium impact
[California] Prior authorization requirement changes effective
Anthem BCBS·CA · Wound Care, PM&R (Physical Medicine & Rehab), Physical Therapy +1 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Blue Cross will require prior authorization for 10 HCPCS codes related to pneumatic and non-pneumatic compression devices for California Medicaid members. Billing teams must implement prior authorization requirements in their systems before this date or claims will be denied.
Action Required
By March 31, 2026: Billing team must update billing software and prior authorization workflows to require Anthem prior authorization for HCPCS codes E0652, E0656, E0657, E0658, E0659, E0670, E0671, E0672, E0673, E0677, and E0683 for all California Medicaid members. Update encounter templates and internal checklists to flag these codes for PA submission. Establish process to submit PAs via Availity Essentials (https://Availity.com), fax (800-754-4708), or phone (888-831-2246 for Medi-Cal or 877-273-4193 for MRMIP) before claims are submitted. Inform providers and clinical staff that non-compliance with these new requirements will result in claim denials. Verify access to Anthem provider portal (https://providers.anthem.com/ca) for detailed PA requirements or contact Medi-Cal Customer Care Center at 800-407-4627 (TTY 711) for assistance.