Prior Authorizations Lists for

Designated Groups

The procedures or services on the lists below may require prior authorization or prenotification by BCBSTX Medical Management or other designated vendor for certain designated groups.

  • These lists are not exhaustive.
  • The presence of codes on these lists does not necessarily indicate coverage under the member/participant’s benefits contract.
  • Consult Availity® or your preferred vendor for eligibility and benefits, the member/participant benefit booklet or contact a customer service representative to determine coverage for a specific medical service or supply.


Employees Retirement System of Texas (ERS) Prior Authorizations

Important Notice

Prior Authorization Update:

ERS Consumer Directed HealthSelectSM In-Area (Texas)

Effective 09/01/2022:

Effective 9/1/2020 - 08/31/2022:

ERS HealthSelect of Texas® In-Area (Texas)

Important: PCP designation and referrals are required for services to be processed at the in-network benefit level on this plan. If a referral is required, one must be on file with BCBSTX prior to obtaining a prior authorization. If a referral and a prior authorization are required, and the participant does not have one on file with BCBSTX before rendering services, the claims you submit may be processed at the lower out-of-network benefit level.

Effective 09/01/2022

Effective 9/1/2020 - 08/31/2022:

ERS HealthSelect of Texas® & Consumer Directed HealthSelectSM Out-Of-State

Effective 09/1/2022

Effective 9/1/2020 -08/31/2022

ERS Specialty Drug List

Effective  9/1/2021 (includes updates effective 09/01/2022):

Effective 9/1/2017 - 08/31/2021:

Related Links

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.

BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or has a recommended clinical review is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.