What’s New: Blue Cross and Blue Shield of Texas (BCBSTX) will be updating its lists of Current Procedural Terminology® (CPT) codes requiring prior authorization, for some commercial members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).
Changes effective Oct. 1, 2022, include:
- Addition of one Musculoskeletal Joint and Spine code to be reviewed by AIM Specialty Health® (AIM)
- Addition of Molecular Genetic Lab Testing codes to be reviewed by AIM
- Addition and replacement of Medical Oncology drugs to be reviewed by AIM
- Addition of Sleep codes to be reviewed by AIM
- Removal of Musculoskeletal Joint and Spine and Pain codes previously reviewed by AIM
- Addition of Specialty Pharmacy codes to be reviewed by BCBSTX
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® 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.
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.