Prior Authorization Code Changes for Commercial Members, Effective July 1, 2025
AI Summary
Blue Cross Blue Shield of Texas is removing molecular genetic testing codes from prior authorization requirements for commercial members effective July 1, 2025. These codes were previously reviewed by Carelon Medical Management but will no longer require prior authorization.
Action Required
Before July 1, 2025: Billing team must update prior authorization checking procedures to remove molecular genetic testing codes from required pre-approval lists. Verify eligibility and benefits through Availity Essentials or preferred vendor to confirm which codes no longer require authorization. Update billing software rules and staff training materials to reflect that these molecular genetic testing codes can be billed without prior authorization for commercial members.
Plan Types
Commercial
States
TX
Specialties
laboratory, oncology, family-medicine, internal-medicine