Medicare AdvantagePrior AuthHigh impact
[California] Precertification/prior authorization requirement changes
Anthem BCBS·CA · Gastroenterology, Urology, Oncology +5 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem will require prior authorization for 25 new medical codes across multiple specialties for Medicare Advantage members in California. These include gastroenterology tests, drug assays, oncology procedures, neurostimulation devices, and various surgical procedures.
Action Required
Before September 1, 2026: Billing team must update prior authorization requirements in billing system for all 25 listed codes for Anthem Medicare Advantage members in California. Update encounter forms and EMR alerts to notify providers that these procedures require precertification. Train staff on new authorization requirements through Availity Essentials. Failure to obtain prior authorization will result in claim denials and services deemed ineligible for payment.