← Back to list
Prior Authorization Changes for Some Commercial and Government Program Members
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
May 3, 2026
Summary
Blue Cross Blue Shield of Texas is implementing multiple prior authorization changes affecting commercial, Medicaid, and Medicare Advantage members starting April 1, 2026. New prior authorization requirements will be added for various services including oncology, advanced imaging, sleep studies, and genetic testing, with different review organizations handling different service types.
Get alerts when payers change rules like this one
We check BCBS Texas and other payers every day and email you when a change matches your specialty and state.
Get BCBS Texas alertsPolicy Monitoring is free. No card required.
What to do
by Apr 1, 2026 · 5 steps
01Billing team must update prior authorization workflows for commercial members to include new requirements for radiation oncology, advanced imaging, sleep studies, molecular genetic lab tests, medical oncology, and drug codes.
02Update staff training on which services require Carelon vs BCBSTX review.
03By July 1, 2026: Implement Part B Step Therapy requirements and new prior auth processes for orthotic, pharmacy, and miscellaneous codes for Medicare Advantage members.
04By June 1, 2026: Update Medicaid prior auth requirements for drug and DME codes.
05Always verify eligibility and prior auth requirements through Availity before rendering services - failure to obtain required prior authorization may result in claim denials and providers cannot bill members directly.
Original notice
Prior Authorization Changes for Some Commercial and Government Program Members
bcbstx.com · Always check the source before changing claims.
Related changes
See all BCBS Texas changes →Prior Authorization Changes for Some Commercial and Government Program MembersHighEffective Oct 1, 2026 · Prior AuthorizationFAQ Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026HighEffective Jan 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighNo effective date · Prior AuthorizationPrior Authorization Changes for Some MembersHighEffective Oct 1, 2026 · Prior AuthorizationBrowse every BCBS Texas change in the policy list