MedicaidPrior AuthMedium impact
[Virginia] Prior authorization requirement changes
Anthem BCBS·VA · Gastroenterology, Oncology, Urology +2 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Starting September 1, 2026, HealthKeepers Inc. will require prior authorization for five new medical procedures/treatments for Virginia Medicaid members, including liver and prostate ablation procedures, neurostimulator devices, and two injection treatments. Services provided without prior authorization may be denied payment.
Action Required
Before September 1, 2026: Billing team must update prior authorization requirements in billing system for CPT codes 47384, 55877, C1607, J3387, and J3389 for Virginia Medicaid patients with HealthKeepers Inc. Train staff to obtain prior auth via Availity Essentials, fax (800-964-3627), or phone (800-901-0020) before scheduling these procedures. Update encounter forms and EMR templates to flag these codes. Claims submitted without prior authorization will be denied payment.