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BCBS TexasCommercial · Prior Auth · Prior Authorization · TX · Radiology, Sleep MedicineHigh impact

Prior Authorization Changes for Some Commercial and Government Program Members, Effective Jan. 1, 2026

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jan 12, 2026

Summary

Blue Cross Blue Shield of Texas is adding new prior authorization requirements effective January 1, 2026. Commercial members will need prior auth for Advanced Imaging, Sleep studies, and Genetic Testing (reviewed by Carelon). Government program members (Medicare Advantage) will need prior auth for Specialty Drugs and Molecular Genetic Lab Testing (reviewed by EviCore).

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What to do

by Jan 1, 2026 · 6 steps
01Billing team must update prior authorization workflows for BCBSTX members.
02For commercial members: require prior auth through Carelon for Advanced Imaging, Sleep studies, and Genetic Testing codes.
03For Medicare Advantage members: require prior auth through EviCore for Specialty Drug and Molecular Genetic Lab Testing codes.
04Always verify eligibility and benefits through Availity portal before rendering services.
05Update staff training on new prior auth requirements.
06Claims without required prior authorization may be denied and providers cannot bill patients.

Original notice

Prior Authorization Changes for Some Commercial and Government Program Members, Effective Jan. 1, 2026
bcbstx.com · Always check the source before changing claims.
View original ↗

Related changes

See all BCBS Texas changes →
Prior Authorization Changes for Some Commercial and Government Program MembersHighEffective Oct 1, 2026 · Prior AuthorizationFAQ Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026HighEffective Jan 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighNo effective date · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighEffective Aug 1, 2026 · Prior AuthorizationBrowse every BCBS Texas change in the policy list

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BCBS Texas policiesTX policy changesRadiologySleep Medicine

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