Recommended Clinical Review Procedure Code List Changes for Certain Members Effective May 15, 2024


BCBCSTX is updating its lists of codes requiring Recommended Clinical Review, for some commercial members, to reflect new, replaced or removed codes. These changes are based on updates from Utilization Management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association (AMA) or Healthcare Common Procedure Coding System (HCPCS) changes from the Centers for Medicaid & Medicare Services.  

More Information: Refer to Recommended Clinical Review Lists on the Utilization Management section of our provider website. Revised lists can be found on the Recommended Clinical Review (CR) Option page on the provider website.

  • Check Eligibility and Benefits: Providers should check eligibility and benefits through Availity® Essentials or their preferred vendor. This may also indicate if a service requires a prior authorization or recommended clinical review.
  • Avoid post-service medical necessity reviews and delays in claim processing by obtaining RCR before rendering services. If services are performed 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 2023 American Medical Association (AMA). 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 BCBSTX.

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