Prior Authorization Services for: - Fully Insured
- Administrative Services Only (ASO) Plans
The procedures or services on the below lists may require prior authorization or prenotification by BCBSTX Medical Management, AIM Specialty Health® or Magellan Healthcare®. These lists
- 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.
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.
Fully Insured Plans
Fully insured plans will have “TDI” indicated on the ID Card.
Services Lists
- Prior Authorization Services List for Fully Insured Plans
Effective 01/01/2021 - Prior Authorization Services List for Fully Insured Plans Effective
through 12/31/2020
Procedure Code Lists
- Prior Authorization Procedure Codes List for Fully Insured Plans
Effective 04/01/2021
Updated 02/15/2021 with AMA code changes effective 01/01/2021 or retired 03/31/2021 - Prior Authorization Procedure Codes List for Fully-Insured Plans
Effective 01/01/2021 – 03/31/2021
(Additional codes were added 12/16/2020 due to AMA code updates) - Prior Authorization Procedure Codes List for Fully-Insured Plans
Effective through 12/31/2020
Administrative Services Only (ASO) Plans
Administrative Services Only (ASO) plans will NOT have “TDI” indicated on the ID Card.
Services Lists
- Prior Authorization Services List for ASO Plans Effective 1/1/2021
- Prior Authorization Services List for ASO Plans Effective 1/1/2020 - 12/31/2020
Procedure Code Lists
- Prior Authorization Procedure Codes List for ASO Plans Effective 04/01/2021 Updated 02/15/2021 with AMA code changes effective 01/01/2021 or retired 03/31/2021
- Prior Authorization Procedure Codes List for ASO Plans Effective 01/01/2021 - 03/31/2021
(Additional codes were added on 12/21/2020 due to AMA code updates) - Prior Authorization Procedure Codes List for ASO Plans Effective 9/1/2020 - 12/31/2020
- Specialty Drugs Prior Authorization List for ASO Plans Effective 1/1/2020 - 12/31/2020
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, 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 Blue Cross and Blue Shield of Texas.
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. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
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.
