10/1/2021 Update to Prior Authorization Codes for Commercial Members
On 08/02/2021, the Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans were updated to include new AMA codes. Refer to the lists for the changes.
What's New: Blue Cross and Blue Shield of Texas (BCBSTX) will be updating its lists of Current Procedural Terminology (CPT®) codes requiring prior authorization, for some commercial members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA) effective Oct. 1, 2021.
- Adding Genetic Testing codes to be reviewed by AIM
- Removal of Nasal and Sinus Surgery codes previously reviewed by BCBSTX
- Removal of a Specialty Pharmacy code previously reviewed by BCBSTX
- Removal of an Orthopedic Musculoskeletal code previously reviewed by BCBSTX
Refer to the revised lists on the Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans page under the Utilization Management section of our provider website.
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.
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.
CPT copyright 2020 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.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through 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.