Prior Authorization Code Changes for Commercial Members Effective April 1, 2025
AI Summary
Blue Cross Blue Shield of Texas is updating prior authorization requirements for commercial members effective April 1, 2025. Multiple specialty areas will have codes added or removed from prior authorization lists, including cardiology, genetic testing, musculoskeletal, medical oncology, and specialty pharmacy codes.
Action Required
By March 31, 2025: Billing team must review and update prior authorization lists from the BCBSTX provider website under Utilization Management section. Check eligibility and benefits through Availity Essentials before rendering services to identify if prior authorization is required. Update billing system workflows to reflect new cardiology, genetic testing, musculoskeletal, medical oncology, and specialty pharmacy code requirements. Failure to obtain required prior authorization will result in claim denials and providers cannot bill patients.
Plan Types
Commercial
States
TX
Specialties
cardiology, oncology, ortho, all-specialties