Update to Prior Authorization Exemption Clinical Guidelines


Previously BCBSTX posted a list of services or codes applicable to the Prior Authorization (PA) Exemptions for Outpatient Care Categories or Inpatient Treatment/Types.

We have recently made some updates to this list and a new TX HB3459 Elective Prior Authorization (PA) Exemption Clinical Guidelines effective Sept. 1, 2023 has been posted to the Prior Authorization Exemption page on the provider website.

Please review the list to determine the applicable maximum allowable units and PA exemption data range in effect for your particular health care services in which you received Prior Authorization Exemption(s). If you provide services beyond these limits, you will need to request concurrent review for the additional services.