Update to Prior Authorization Codes for Medicaid Members
What’s Changing: Blue Cross and Blue Shield of Texas (BCBSTX) prior authorization requirements for Medicaid members will be updated effective Jan.1, 2022 to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).
Changes will include
- Removal of Radiation Therapy codes previously reviewed by eviCore
- Removal of Lab codes previously reviewed by eviCore
- Removal of Musculoskeletal codes previously reviewed by eviCore
- Removal of Radiology codes previously reviewed by eviCore
- Removal of Specialty Pharmacy codes previously reviewed by eviCore
- Removal of Medical Oncology codes previously reviewed by eviCore
- Addition of a Specialty Drug code to be reviewed by eviCore
- Removal of a Specialty Drug code previously reviewed by eviCore
- Addition of Radiology codes to be reviewed by eviCore
- Addition of Genetic Lab codes to be reviewed by eviCore
- Removal of Physical Health codes previously reviewed by BCBSTX
To view the prior authorization list, go to Prior Authorization Lists and Reports on the Utilization Management section of our Medicaid provider website. 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.
Always 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. Continue to watch for updates in the Blue Review and News and Updates for future updates
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.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for 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.
