10/25/2024
What’s New: We are changing prior authorization requirements for Blue Cross and Blue Shield of Texas Medicaid members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association.
Changes effective Jan. 1, 2025, include:
- Medical Oncology drug codes previously reviewed by eviCore to be reviewed by BCBSTX
- Addition of one Behavioral Health code to be reviewed by BCBSTX
More Information: Refer to our updated Prior Authorization Lists and Reports on the Utilization Management section of our Medicaid provider website.
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 2023 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.
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.