Effective Jan. 1, 2023, certain procedure codes are being updated to require prior authorization for HealthSelect of Texas® & Consumer Directed HealthSelectSM participants.
The following codes will require prior authorization as of Jan. 1, 2023:
- 43500 Surgical Opening of Stomach
- 43631 Removal of Stomach Partial
- 43632 Removal of Stomach Partial
- 43840 Repair of Stomach Lesion
- 43845 Gastroplasty Duodenal Switch
- 43850 Revise Stomach-Bowel Fusion
- 43870 Repair Stomach-Opening
- 43880 Repair Stomach-Bowel Fistula
In addition, the following code will not require prior authorization as of Jan. 1, 2023:
- 93352 Admin Ecg Contrast Agent
Beginning 1/1/2023, please refer to the updated HealthSelect of Texas® Prior Authorization Waiver List as of 01/01/2023 which replaces the previously published HealthSelect of Texas® Prior Authorization Removals as of 9/1/2021.
BCBSTX is currently working on system updates to reflect this change.
Remember to use Availity® or your preferred vendor to check eligibility and benefits before rendering services. This will help you confirm coverage details and prior authorization requirements and determine if you are in-network for the member's policy. Refer to Eligibility and Benefits for details.
If you have questions, contact your local Network Management Representative.
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 BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.