Dec. 17, 2021
Effective 1/1/2022, our Blue Cross and Blue Shield of Texas (BCBSTX) Federal Employee Program (FEP®) participants will have some changes to their prior authorization requirements and benefits.
Prior Authorization Updates
- Kidney transplants will now require prior approval and are now part of the Blue Distinction Centers for Transplants® (BDCT) Program.
- Pancreas transplants continue to require prior approval but are removed from the BDCT program
- Air Ambulance (non-emergent) transport from one facility to another requires prior approval and falls under the No Surprise Billing Act .
Be sure to check eligibility and benefits through FEP Customer Service or Availity® for specifics on FEP member benefits. The following have changes to benefits:
- Gender Reassignment Surgery (GRS)
- EKG will no longer be considered part of the preventive benefit. There must be a medical necessity.
- Specialty drug pharmacy will be administered by CVS Caremark. For Blue Focus members, Walgreens and Duane Reade Pharmacies will no longer be in-network. For more information, refer to the FEP Pharmacy page or call 1-888-346-3731.
- Emergency medical services performed in the emergency department of a hospital or urgent care centers, licensed as and permitted to provide emergency services that do not contract with our Blue Cross and Blue Shield Plan, will be reimbursed in accordance with federal laws and regulations, such as the No Surprise Billing Act.
If you have any questions, contact our FEP Customer Service at 1-800-442-4607.