MedicaidPrior AuthMedium impact
[California] Prior authorization requirement changes
Anthem BCBS·CA · Gastroenterology, Urology, Neurosurgery +2 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 13 specific medical codes for Medi-Cal Managed Care members in California, including liver and prostate ablation procedures, spinal decompression, baroreflex activation therapy systems, and specialized injections. Services performed without proper precertification may be denied payment.
Action Required
By September 1, 2026: Billing team must update system to require prior authorization for codes 47384, 55877, 62330, 62331, 64654-64659, 93145, 93146, C1607, J3387, and J3389 for all Anthem Medi-Cal Managed Care members. Train staff to request precertification via Availity Essentials, fax (800-754-4708), or phone (888-831-2246) before scheduling these procedures. Update encounter forms and EMR alerts. Claims without proper prior authorization will be denied payment.