Prior Authorization Code Updates for Medicare Advantage, Effective July 1, 2025
AI Summary
Blue Cross Blue Shield of Texas is adding new specialty drug codes and lab codes that will require prior authorization review by eviCore for Medicare Advantage members, effective July 1, 2025. The specific codes affected are not listed in this announcement but will be detailed in revised prior authorization lists.
Action Required
By July 1, 2025: Billing team must review the revised prior authorization lists from BCBSTX to identify the new specialty drug and lab codes requiring eviCore review. Update billing system to flag these codes for prior authorization verification. Check eligibility and benefits through Availity Essentials before rendering services. Failure to obtain required prior authorization may result in claim denials with no member billing allowed.
Plan Types
Medicare Advantage
States
TX
Specialties
all-specialties