Prior authorization requirement changes

Effective September 1, 2025, precertification/prior authorization requirements will change for the following code(s). The medical code(s) listed below will require precertification/prior authorization by Anthem for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification/prior authorization rules and must be considered first when determining coverage.

If the requirements are not met, those services may be deemed ineligible for payment.

Providers may appeal online through Availity Essentials (https://Availity.com) or contact Provider Services at 800‑450‑8753 with additional information, which may include medical records.

Precertification/prior authorization requirements will be added for the following code(s):

You can request precertification/prior authorization by:

• Online: Availity Essentials is available at https://Availity.com.
• Fax: 800-964-3627
• Phone: 800-450-8753

Not all precertification/prior authorization requirements are listed here. Detailed precertification/prior authorization requirements are available to providers on https://www.anthembluecross.com/ny/provider or for contracted providers by accessing https://Availity.com. Providers may also contact Provider Services at 800‑450‑8753 for assistance with precertification/prior authorization requirements.