April 2, 2025
We’re changing prior authorization requirements for members of Medicare Advantage to reflect new, replaced or removed codes. Changes are based on updates from utilization management or the American Medical Association.
Changes include:
- July 1, 2025 – Addition of specialty drug codes to be reviewed by eviCore
- July 1, 2025 – Addition of lab codes to be reviewed by eviCore
For more information, refer to the revised prior authorization lists.
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 don’t meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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 Blue Cross and Blue Shield of Texas.
eviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.