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BCBS TexasMedicare Advantage · Prior Auth · Prior Authorization · TX · Oncology, Radiology, OrthopedicsHigh impact

Prior Authorization Code Updates for Medicare Advantage, Effective Oct. 1, 2025

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jan 12, 2026

Summary

Blue Cross Blue Shield of Texas is updating prior authorization requirements for Medicare Advantage members effective October 1, 2025. Key changes include removing musculoskeletal codes from EviCore review, adding new specialty drug and lab codes to EviCore review, and transferring proton beam codes from BCBSTX to EviCore review.

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What to do

by Oct 1, 2025 · 4 steps
01Billing team must review and update prior authorization workflows for BCBSTX Medicare Advantage members.
02Check the updated prior authorization lists on the BCBSTX website to identify specific codes affected.
03Update billing system rules to reflect removed musculoskeletal codes (no longer requiring prior auth), new specialty drug and lab codes requiring EviCore review, and proton beam codes now reviewed by EviCore instead of BCBSTX.
04Verify prior authorization requirements through Availity Essentials before rendering services to avoid claim denials.

Original notice

Prior Authorization Code Updates for Medicare Advantage, Effective Oct. 1, 2025
bcbstx.com · Always check the source before changing claims.
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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 MembersHighEffective Oct 1, 2026 · Prior AuthorizationBrowse every BCBS Texas change in the policy list

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BCBS Texas policiesTX policy changesOncologyRadiologyOrthopedics

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