The procedures or services on the below lists may require prior authorization or prenotification by BCBSTX Medical Management, AIM Specialty Health® or Magellan Healthcare®.
- Are not exhaustive.
- May not necessarily be covered under the member benefits contract.
- May periodically be updated to comply with American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) guidelines including procedure code updates.
Providers should check eligibility and benefits through Availity® or your preferred vendor, check the member/participant benefit booklet or contact a customer service representative to determine coverage for a specific medical service or supply.
Prior Authorization Services List
The following is a list of Services that may require prior authorization for fully insured or ASO members as of 01/01/2022:
Fully Insured Plans
*Fully insured plans will have “TDI” indicated on the ID Card.
- Prior Authorization Services List for Fully Insured Plans Effective 01/01/2021 - 12/31/2021
Procedure Code Look Up
Locate procedure codes that may require prior authorization for Fully Insured Members Only using the following:
Digital Lookup Tool
Select the appropriate category below to find out if a member’s procedure may require prior authorization:
Procedure Code Lists
Prior Authorization Procedure Codes List for Fully Insured Plans Effective 01/01/2022 (Updated to include code changes effective 10/01/2022)
Administrative Services Only (ASO) Plans
Administrative Services Only (ASO) plans will NOT have “TDI” indicated on the ID Card.
Services Lists (prior to 1/1/2022)
Procedure Code Lists
- Prior Authorization Procedure Codes List for ASO Plans Effective 01/01/2022 (Updated to include code changes effective 10/01/2022)
AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent medical benefits management company that provides utilization management services for Blue Cross and Blue Shield of Texas.
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.
BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity, eviCore or AIM. The vendors are solely responsible for the products or services they offer.
Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits 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.