MedicaidPrior AuthMedium impact
[New York] Prior authorization requirement changes
Anthem BCBS·NY · Gastroenterology, Urology, Neurosurgery +1 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem Medicaid in New York will require prior authorization for five specific medical codes including liver and prostate ablation procedures, neurostimulator devices, and two injection treatments. Claims submitted without proper precertification will be denied payment.
Action Required
Before September 1, 2026: Billing team must update prior authorization requirements in billing system for codes 47384, 55877, C1607, J3387, and J3389 for Anthem Medicaid patients. Update encounter forms and provider workflows to trigger prior auth requests via Availity Essentials, fax (800-964-3627), or phone (800-450-8753). Train staff on new precertification process as services may be denied payment without proper authorization.