The procedures or services on the below lists may require prior authorization or prenotification by medical management for Blue Cross and Blue Shield of Texas or EviCore healthcare.
- These lists are not exhaustive.
- The presence of codes on these lists does not necessarily indicate coverage under the member benefits contract. Member contracts differ in their benefits.
- Consult Availity® Essentials or your preferred vendor for eligibility and benefits, the member benefit booklet or contact a customer service representative to determine coverage for a specific medical service or supply.
Blue Cross Medicare AdvantageSM Prior Authorization Requirement List
Blue Cross Medicare Advantage Procedure Code List
Blue Cross Medicare Advantage Procedure Code List Change Summary
Related Links
- Availity Authorizations & Referrals
- EviCore healthcare
- MCG Care Guidelines (Accessible to providers through the BCBSTX-branded Payer Spaces section in Availity under the Resources tab – use CTRL+F to locate specific criteria within the MCG Care Guidelines.
- Medical policies
EviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.