Blue Cross and Blue Shield of Texas (BCBSTX) is removing some outpatient services from requiring prior authorization, effective Sept. 18, 2022, for fully insured plans (TDI on ID card) and certain Administrative Services Only (ASO)1 groups.
The below outpatient services will no longer require prior authorization:
- Durable Medical Equipment (DME)
- Physical Therapy, Occupational Therapy and Speech Therapy (PT/OT/ST) – Except Coordinated Home Care (home health) services continue to require PA.
- Chiropractic Services
- Dental/Accident Injury
Refer to the provider website for a list of outpatient procedure codes in the above outpatient categories where a predetermination of benefits can be submitted to determine coverage and whether BCBSTX considers it medically necessary using the current predetermination process.
Be sure to check eligibility and benefits via Availity® Essentials or your preferred electronic vendor prior to rendering services. This process will also notify you if the service requires prior authorization or is eligible for Recommended Clinical Review for your member.
Visit the Utilization Management page on our provider website for more information on our revised Prior Authorization Lists reflecting the removal of services that no longer require a prior authorization.
Watch News and Updates for more information.
1 Refer to the website for current list
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