May 29, 2019
Blue Cross and Blue Shield of Texas (BCBSTX) has updated its Specialty Pharmacy Infusion Site of Care Prior Authorization Drug List for two codes to reflect changes to the Healthcare Common Procedure Coding System (HCPCS) codes assigned by The Centers for Medicare & Medicaid Services (CMS). The following codes have been updated:
- Fasenra — changed from C9466 to J0517
- Radicava — changed from C9493 to J1301
The 2019 Specialty Drugs Prior Authorization List for Infusion Site of Care list can be found on the BCBSTX provider website under Clinical Resources, Prior Authorizations/Notifications/Referral Requirements.
For these select drugs, you may need to submit a benefit prior authorization request to BCBSTX before administration of the drug and selection of Infusion Site of Care.
We encourage you to check eligibility and benefits via an electronic 270 transaction through the Availity® Provider Portal or your preferred vendor portal. It's also important to check eligibility and benefits for each patient at every visit to confirm coverage details. This step also helps you identify benefit prior authorization/prenotification requirements.
You may also call the number on the member's ID card for assistance.
It is also important to stay current with the BCBSTX Medical Policy, "Specialty Medication Administration Site of Care" RX 501.096.
For more information refer to the Prior Authorizations/Notifications/Referral Requirements web page and Specialty Pharmacy Program web page on our provider website or contact your Network Management Representative.
Checking eligibility and benefits and/or obtaining benefit prior authorization/prenotification or predetermination of benefits is not a guarantee that benefits will be paid. Payment 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 your patient's policy certificate and/or benefits booklet and or summary plan description. Regardless of any benefit determination, the final decision regarding any treatment or service is between you and your patient.
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 any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.