Revision to Prior Authorization Codes for Commercial Members
On Sept. 29, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) announced changes to the commercial member prior authorization procedure code lists effective Jan. 1, 2022.
Additional Code Removals
We have updated the lists of procedure codes, for some commercial members, to reflect removing some additional codes from requiring prior authorization through BCBSTX or AIM Specialty Health® (AIM) due to updates from Utilization Management or the American Medical Association (AMA).
The revisions effective Jan. 1, 2022 include the removal of some codes in the following categories:
- Reviewed by BCBSTX
- Spinal Cord Stimulation codes
- Multiple Stimulation codes
- Reviewed by AIM
- Cardiology codes
- Radiation Oncology codes
- Advanced Imaging codes
- Medical Oncology codes
The Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans page under the Utilization Management section of our provider website include the revised lists. Refer to AIM’s website for available training sessions.
Check Eligibility and Benefits
To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Cardiology (Echo) Reminder:
The updates posted Sept. 29, 2021 include the addition of several cardiology (echo) codes to be reviewed by AIM as of Jan. 1, 2022. Be sure to review the list if your practice provides or refers for these services.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX.
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.