10/01/18 Update to the Blue Cross Medicare Advantage Preauthorization List
Blue Cross and Blue Shield of Texas (BCBSTX), has made updates to the preauthorization requirements for psychological and neuropsychological testing procedures to help improve member access and help decrease provider administrative responsibilities. These changes affect Blue Cross Medicare Advantage (PPO)SM and take effect 10/1/2018. The Blue Cross Medicare Advantage Preauthorization Procedure Code List has been revised to remove the following codes, as they no longer require preauthorization.:
- 96101 – Psychological Testing
- 96102 – Psychological Testing
- 96103 – Psychological Testing
- 96118 – Neuropsychological Testing
- 96119 – Neuropsychological Testing
- 96120 – Neuropsychological Testing
For in-network providers, benefit preauthorization of routine psychological and neuropsychological testing is no longer required. Prior authorization will only be enforced if BCBSTX determines a provider’s pattern of testing varies significantly from their provider peer group. Additionally, periodic auditing will be conducted by BCBSTX to evaluate that testing is consistent with the presenting clinical issue, national and local coverage determinations, medical policy and benefit plan design. If benefit preauthorization is required or testing is not consistent with the presenting clinical condition, national and local coverage determinations, medical policy and benefit plan design, BCBSTX will contact the provider to obtain additional information.
Thank you for your cooperation as we work to optimize our Care Management program to better serve our providers and members.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
Please note that the fact that a service has been preauthorized/pre-certified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.