Medicare AdvantagePrior AuthMedium impact
[California] Prior authorization requirement changes
Anthem BCBS·CA · Gastroenterology, Oncology, Urology +5 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Medicare Advantage plans in California will require prior authorization for 27 specific medical codes starting September 1, 2026. These codes cover specialized procedures including neurostimulation, oncology testing, gastric procedures, and fertility treatments.
Action Required
By September 1, 2026: Billing team must update prior authorization requirements in billing system for the 30 specified codes affecting Anthem Medicare Advantage HMO, C-SNP, and I-SNP members in California. Update encounter forms and provider alerts for these procedures. Train staff on new precertification process through Availity Essentials. Services performed without prior authorization may be denied payment.