What’s New: Due to updates from Blue Cross and Blue Shield of Texas (BCBSTX) Utilization Management or the American Medical Association (AMA), we are updating are prior authorization lists for some commercial members. These updates reflect new, replaced or removed codes.
- Effective March 1, 2022 - Replacement of Medical Oncology code J2505 with code J2506 reviewed by AIM Specialty Health® (AIM)
- Effective April 1, 2022, removal of:
- Orthopedic Musculoskeletal codes previously reviewed by BCBSTX
- Wound Care code previously reviewed by BCBSTX
- Musculoskeletal Joint and Spine codes previously reviewed by AIM
- Musculoskeletal Pain codes previously reviewed by AIM
Refer to Prior Authorization Lists on the Utilization Management section of our provider website, Revised lists can be found on the Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans.
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® Essentials or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
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 BCBSTX.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors..