Blue Cross Medicare Advantage Prior Authorization Updates effective Sept. 1, 2020

June 3, 2020

On Sept. 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will update its list of Blue Cross Medicare Advantage Prior Authorization Procedure Codes to comply with the American Medical Association (AMA). These changes are the result of new, replaced or removed codes implemented by the AMA.

What’s New: Providers will need to utilize the new list of procedure codes on the Prior Authorization & Predetermination page when determining if a service requires prior authorization Sept. 1, 2020, and after. Scroll to and open the Blue Cross Medicare Advantage PPOSM and Blue Cross Medicare Advantage HMOSM section. You can view the Blue Cross Medicare Advantage Prior Authorization Requirement List, Blue Cross Medicare Advantage Procedure Code List and Blue Cross Medicare Advantage Procedure Code List Change Summary. You can also use Availity® or your preferred vendor for prior authorization requirements.

Check Eligibility and Benefits: Prior to rendering services, providers should use Availity or your preferred vendor to check eligibility and benefits to confirm membership, check coverage, determine if you are in-network for the member's policy and determine whether prior authorization is required. Availity allows prior authorization determination by procedure code and providers can submit requests on Availity using the Authorization & Referral tool. Refer to the BCBSTX Eligibility and Benefits page for more information on Availity. Payment may be denied if you perform procedures without authorization. If this happens, you may not bill your patients.

More Information: Check the AMA website for more information on CPT codes. If you have questions, contact your Network Management Office location.


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