Medicare AdvantagePrior AuthHigh impact
[Virginia] Precertification/prior authorization requirement changes
Anthem BCBS·VA · Gastroenterology, Urology, Neurosurgery +6 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem Medicare Advantage plans will require precertification/prior authorization for 26 specific medical codes including gastroenterology tests, neurostimulation procedures, spinal decompressions, and various specialized treatments. Services performed without proper authorization may be denied payment.
Action Required
By September 1, 2026: Billing team must update prior authorization requirements for 26 specific codes in billing system and encounter forms. Staff must obtain precertification through Availity Essentials or Provider Services before performing these procedures for Anthem Medicare Advantage members. Claims may be denied without proper authorization - appeals can be submitted with medical records if needed.