Medicare AdvantagePrior AuthMedium impact
Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2025
BCBS Texas·TX·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas is updating prior authorization requirements for Medicare Advantage members effective April 1, 2025. Changes include adding new specialty drug codes and lab management codes that will require eviCore review, while removing some previously required lab management codes.
Action Required
Before April 1, 2025: Billing team must review the updated Prior Authorization Lists for Blue Cross Medicare Advantage (PPO) and (HMO) on the BCBSTX provider website to identify new specialty drug and lab management codes requiring eviCore prior authorization. Update billing system workflows to check eligibility and benefits through Availity Essentials before rendering services. Failure to obtain required prior authorization may result in claim denials and providers cannot seek reimbursement from members.