What’s Changing: Blue Cross and Blue Shield of Texas (BCBSTX) is changing prior authorization requirements for Medicaid members to reflect new, replaced, or removed codes due to updates from Utilization Management or the American Medical Association (AMA). A summary of changes is included below.
Medicaid: Refer to Prior Authorization Lists and Reports on the Utilization Management section of our Medicaid provider website. The revised lists can be found on the Prior Authorization List for Medicaid toward the bottom of the page.
- April 1, 2022 – Replacement of Medical Oncology code J2505 with code J2506 reviewed by eviCore Healthcare
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.