This page includes the commercial prior authorization summaries and code lists that were posted as of the end of the year for the past two years.
2025
- Recommended Clinical Review Services List for Employees Retirement System of Texas – Effective Jan. 1, 2025
- Recommended Clinical Review List for Teacher Retirement System of Texas – Effective Jan. 1, 2025 (Updated March 1, 2025)
2024
- Recommended Clinical Review Inpatient Services List for Fully Insured and Certain Administrative Services Only Groups – Effective Jan. 1, 2024
- Recommended Clinical Review Services List for Employees Retirement System of Texas – Effective Sept. 1, 2024 − Dec. 31, 2024.
- Recommended Clinical Review List for Teacher Retirement System of Texas – Effective Sept. 1, 2024 − Dec. 31, 2024
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. If you have any questions, call the number on the member's BCBSTX ID card.