Preauthorization Requirements

UT SELECT requires advance approval (preauthorization) by Blue Cross and Blue Shield of Texas (BCBSTX) for certain services. Preauthorization establishes in advance (or within 48 hours following an emergency hospital admission) the medical necessity of certain care and services covered under UT SELECT. Your health care provider should initiate the request for preauthorization since medical records may be required.

The following types of services require preauthorization:

• All inpatient hospital admissions
• Skilled nursing care in a skilled nursing facility
• Home health care
• Hospice care
• Home infusion therapy (in a home setting)
• Motorized and customized wheelchairs and certain other durable medical equipment totaling over $5,000
• Transplants
• All inpatient treatment of mental health care, chemical dependency and serious mental illness; and
• The following outpatient treatment of mental health care, chemical dependency and serious mental illness:
  • Electroconvulsive therapy
  • Repetitive transcranial magnetic stimulation, and
  • Intensive outpatient program.

Care should also be preauthorized if you or your doctor wants to:

• Extend your hospital stay beyond the approved days (you or your doctor must call for an extension before your approved stay ends)
• Transfer you to another facility or to or from a specialty unit within the facility

The following outpatient services:

• Advanced imaging procedures such as CT, MRI, PET scans
• Sleep studies and related medical equipment/supplies
• Pain management procedures
• Joint and spine surgery
• Cardiology procedures

Some additional outpatient procedures may require provider preauthorization.

If you have any questions about your benefits, contact a health advocate at 1-866-882-2034, Monday – Friday 7 a.m. to 7 p.m. CT.