Prior Authorization Changes for Some Government Program Members
AI Summary
Blue Cross Blue Shield of Texas is changing prior authorization requirements for Medicare Advantage and Medicaid members effective July and August 2026. Some cardiology and lab codes will no longer require prior authorization, while new miscellaneous codes will be added to the prior auth requirement list.
Action Required
By June 30, 2026: Billing team must update prior authorization workflows to reflect removal of cardiology codes from EviCore review and lab/miscellaneous codes from BCBSTX review for Medicare Advantage members. By July 31, 2026: Add new miscellaneous codes to BCBSTX prior authorization requirements. Always verify current prior auth requirements through Availity Essentials before rendering services. Services without required prior authorization may be denied.
Plan Types
Medicare Advantage, Medicaid
States
TX
Specialties
cardiology, laboratory, all-specialties