Additional Update to Prior Authorization Codes for Medicaid Members, Effective July 1


What’s Changing: Blue Cross and Blue Shield of Texas (BCBSTX) is changing prior authorization requirements for Medicaid members to reflect new, replaced or removed Current Procedural Terminology® (CPT) codes due to updates from Utilization Management or the American Medical Association (AMA) effective July 1, 2022. A summary of changes is included below.

Medicaid: Refer to our Medicaid Provider website on the Utilization Management section for the  Prior Authorization Lists and Reports

Changes include

  • Removal of one Molecular Genetic Lab Testing code previously reviewed by eviCore
  • Replacement of Molecular Genetic Lab Testing codes reviewed by eviCore

Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity®  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.

eviCore healthcare (eviCore) 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.