Anthem Updates Prior Authorization Requirements Effective March 1, 2026

Anthem Blue Cross and Blue Shield (Missouri) has announced changes to its prior authorization (precertification) requirements for Medicare members, effective March 1, 2026. Several laboratory, procedural, and emerging-technology codes will now require authorization before services are rendered. Anthem notes that services performed without required authorization may be deemed ineligible for payment.

Newly added PA requirements include:

• 0556U, 0563U, 0564U – Multiplex respiratory pathogen DNA/RNA panels (molecular PCR)
• 0978T–0980T – Submucosal cryolysis therapy procedures
• E3200 – Gait modulation rhythmic auditory stimulation system
• J3391 – Atidarsagene autotemcel (gene therapy), per treatment

Anthem encourages practices and facilities to review the full updated Prior Authorization (PA) list, as not all requirements are reflected in the notice. Providers may submit appeals or supporting documentation through Availity or by contacting Provider Services.

Provider impact:

These changes will require updates to intake, scheduling, authorization, and EHR workflows—particularly for labs performing high-volume respiratory molecular testing and facilities implementing emerging therapeutic technologies. Missing PA documentation may lead to claim denials, pended claims, or delayed reimbursement, making proactive review essential.

The full PA requirements can be found at anthem.com/provider or through the Availity provider portal.

Source: https://providernews.anthem.com/missouri/articles/prior-authorization-requirement-changes-27389