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.
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.
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
Procedure Code Lists
- Prior Authorization Procedure Codes List for Fully Insured Plans
Includes changes effective 10/1/2021 and 10/11/2021 - Prior Authorization Procedure Codes List for Fully Insured Plans
Effective 07/01/2021
Updated 06/9/2021 to remove certain pain management codes and add new AMA Genetic Testing codes
Updated 6/1/2021 to remove 64640 - Prior Authorization Procedure Codes List for Fully Insured Plans
Effective 04/01/2021 - 06/30/2021 - Prior Authorization Procedure Codes List for Fully-Insured Plans
Effective 01/01/2021 – 03/31/2021
Administrative Services Only (ASO) Plans
Administrative Services Only (ASO) plans will NOT have “TDI” indicated on the ID Card.
Services Lists
Procedure Code Lists
- Prior Authorization Procedure Codes List for ASO Plans Effective 10/1/2021 and 10/11/2021
- Prior Authorization Procedure Codes List for ASO Plans Effective 07/01/2021
Updated 06/9/2021 to remove certain pain management codes and add new AMA Genetic Testing codes
Updated 6/1/2021 to remove 64640 - Prior Authorization Procedure Codes List for ASO Plans Effective 04/01/2021 – 06/30/2021
- Prior Authorization Procedure Codes List for ASO Plans Effective 01/01/2021 - 03/31/2021
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.
