April 17, 2025

We’re changing prior authorization requirements for members of Medicaid to reflect new, replaced or removed codes due to updates from Utilization Management prior authorization assessment, Current Procedural Terminology (CPT^®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.

Medicaid: Refer to Prior Authorization Lists and Reports on the Utilization Management section of our Medicaid provider website.

Changes effective July 1, 2025, include:

• Addition of durable medical equipment codes to be reviewed by BCBSTX
• Addition of medical drug codes to be reviewed by BCBSTX

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.

CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.

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.

BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.