MedicaidPrior AuthMedium impact
[Virginia] Medical Policies and Clinical Utilization Management Guidelines update
Anthem BCBS·VA · Plastic Surgery, Dermatology, Pain Management +9 more·Prior Authorization
Effective date
Jun 19, 2026
We identified it
Jun 13, 2026
Summary
Virginia HealthKeepers (BCBS) has updated multiple medical policies and clinical utilization management guidelines effective June 19, 2026, affecting Medicaid members. Changes include revisions to coverage criteria for various services including gene therapy, surgical treatments, medical devices, and new guidelines for assisted reproductive technology and sleep testing that may impact prior authorization requirements.
Action Required
By June 19, 2026: Review all updated medical policies and clinical UM guidelines on the HealthKeepers Medical Policies & Clinical UM Guidelines website. Billing team must verify current prior authorization requirements for affected services including cosmetic/reconstructive skin procedures, electrical stimulation devices, gene therapies, sleep apnea surgeries, wheelchairs and mobility devices, hearing aids, sleep testing, bariatric surgery, and assisted reproductive technology. Update prior authorization workflows as some previously covered services may now require additional documentation or may be deemed not medically necessary.