Submit prior authorization via secure portal; authorization not a payment guarantee

Prior Authorization is not a guarantee of benefits or payment at the time of service; reimbursement of authorized services depends on member eligibility and benefit limitations/exclusions. Registered users may submit electronic preauthorization requests via the secure provider portal; call the number on the member's ID card for portal information. Newly published or emerging codes/therapies may require prior authorization—check with Baylor Scott & White Health Plan before providing these services.

• Prior authorization does not guarantee payment; benefits determined by member's plan and eligibility at time of service.
• Submit preauthorization electronically using the secure provider portal (registered users).
• Contact the number on the member ID card or Provider Relations Representative for assistance.
• Newly published or emerging codes/therapies may require prior authorization—verify with the plan prior to service.

Verify member benefits and contact customer service/portal

Verify member benefits and coverage before providing services by consulting the member benefit booklet or contacting customer service using the number on the member's ID card.

• Check member eligibility, benefit limitations/exclusions, and evidence of coverage provisions prior to service.
• Call the customer service number printed on the member's ID card for portal and coverage information.

Use listed CPT codes for spine arthrodesis and instrumentation

When billing spine arthrodesis or spinal instrumentation, use the listed CPT arthrodesis and instrumentation codes (examples shown) exactly as described in the code list.

• Example codes in this group include 22586, 22600, 22612, 22614, 22630, 22632 (and ranges 22800–22848 referenced elsewhere).
• Follow the code descriptors and effective/mapping dates provided in the policy listing when submitting claims.

Bill interbody device procedures with the listed CPT codes

For interbody device procedures (insertion, revision, removal), bill using the specified interbody device CPT codes as listed in the policy.

• Example codes include 22854, 22856, 22857, 22858 and 22899 for unlisted spine procedures.
• Submit claims using the exact CPT descriptors and note any listed effective dates or mappings from the policy.

Report major joint arthroplasty with specified CPT codes

Major joint arthroplasty procedures must be reported with the listed arthroplasty CPT codes from the policy.

• Shoulder arthroplasty examples: 23465–23474.
• Hip/knee examples: 27130, 27132, 27134, 27447 (total knee arthroplasty) and related revision codes.

Use listed arthroscopy CPT codes for shoulder, hip, knee

Arthroscopy procedures for shoulder, hip, and knee must be billed with the arthroscopy CPT codes shown in the code list.

• Examples include shoulder arthroscopy codes 29805–29828 and hip/knee arthroscopy codes 29860–29889 and 29914–29916.
• Use mappings noted in the policy where hip arthroscopy descriptors are equated to knee arthroscopy descriptors for coding reference.

Apply orthopedics CPT code mappings and effective dates

Follow the CPT code mappings and effective dates provided for orthopedic arthroscopy and related procedures when selecting codes.

• Mapping examples listed include ranges 29876–29883, 29884–29889 and 29914–29916; adhere to the descriptors and effective date annotations in the policy.

Bill rhinoplasty/ENT procedures with listed CPT codes

Use the specified rhinoplasty/ENT CPT codes shown in the listing when billing nasal reconstruction or rhinoplasty services.

• Rhinoplasty code range examples include 30400–30469; follow listed descriptors and referenced dates.

Use listed CPT codes for cardiac and transcatheter procedures

Report high‑acuity cardiac and transcatheter procedures using the CPT codes and descriptors listed in the policy.

• Examples include transcatheter and device procedure codes such as 33340, 33361–33366, 33418, 33477 and 33927–33935.
• Observe the effective dates shown for each cardiac/transcatheter code entry.

Refer to the partial CPT procedure code list when billing

When billing the partial CPT list provided, use the exact CPT procedure codes and descriptors shown in the policy excerpt.

• Partial list examples include 50380, 53410, 53430, 53450, 53451–53454, 54125, 54400–54417 and many others as listed.
• Adhere to the policy's descriptors and effective date notes when submitting claims.

Code listing provided for reference; check portal for authorization requirements

The code listings in chunk 72 and neighboring sections enumerate CPT codes with descriptors but do not include explicit prior authorization rules—treat these as informational coding references and verify authorization requirements separately.

• Examples in this window include 63047–63057 and related spine/neuro codes.
• Check the plan's prior authorization portal for which codes require authorization despite being listed here.

Use code equivalencies and effective dates for coding crosswalks

Code equivalencies and effective dates shown in the policy (e.g., CTA chest codes mapped to MRI equivalents) are informational; use the exact code mappings and effective date annotations when selecting codes for billing or crosswalks.

• Examples: 71550–71552 CTA chest mappings to MRI chest codes; effective date annotations are provided alongside each mapping.
• No explicit prior authorization action is stated in this equivalency section—verify authorization separately.

Bill radiation therapy/SBRT with listed CPT codes and course limits

Radiation therapy and SBRT procedures should be billed with the listed therapeutic radiology CPT codes and note the policy’s course/fraction guidance.

• SBRT treatment delivery/management codes include 77435, 77469, 77470 and related codes; descriptors note 'entire course not to exceed 5 fractions.'
• Follow the listed effective dates for each radiation therapy code when billing.

Use listed CPT codes for brachytherapy and radioelement infusions (follow descriptor notes)

Brachytherapy and radioelement infusion procedures must be reported using the listed CPT codes and descriptors; note that many entries include follow-up care in the descriptor language.

• Example codes include 77761–77763, 77767–77772, 77778, 77789–77799.
• Descriptors often state that infusion/instillation includes 3-month follow-up care—follow descriptors when documenting and billing.

Bill PET and radiopharmaceutical localization with listed CPT codes

PET and radiopharmaceutical localization services must be billed with the CPT codes and descriptors listed for nuclear medicine and PET procedures.

• Examples include radiopharmaceutical localization codes 78800–78804 and PET codes 78811–78816.
• Use the policy’s descriptors and effective dates when reporting these services.

Ensure genomic panels meet the policy's minimum gene-count and composition requirements

Genomic sequence analysis panels must meet panel composition and minimum gene-count requirements specified by code when applicable (examples provided in the policy).

• Example: hearing loss panel code 81430 must include sequencing of at least 60 genes.
• Example: certain Noonan spectrum panels must include at least 12 genes; other panels may require a minimum of 5 genes as specified.

Report cardiovascular procedures with listed CPT codes and effective dates

Use the listed cardiovascular CPT codes for cardiology procedures and catheterization services as provided in the policy, observing the effective date annotations.

• Cardiology code examples include 93455–93461 and related left/right heart catheterization codes.
• Follow the effective date (May 01, 2026) and any per-code date annotations when billing.

Bill proprietary laboratory/tests with listed U-/T-/M-codes and follow specimen notes

Proprietary laboratory and algorithmic test services must be billed using the U-/T-/M-codes listed in the policy and with the specified test descriptors and specimen notes.

• The policy enumerates multiple U-codes (e.g., 0003U–0118U, 0037U, 0105U–0111U) with brief test descriptions and referenced dates.
• Follow the listed specimen requirements (e.g., FFPE, plasma) and effective/reference dates when ordering and billing.

Use the 0105U–0111U code excerpt and descriptors for those proprietary tests

Refer to the code excerpt for sample proprietary lab and procedure codes (0105U–0111U) and use those exact codes and descriptors when billing those specific tests.

• Examples: 0105U (RKFD probability score algorithm), 0106U (13C spirulina breath test), 0107U (C. difficile antigen detection).
• Observe the policy's effective/reference dates when submitting claims.

Bill extended proprietary and specialized test codes as listed

Use the extended proprietary code list when billing the additional specialized tests (e.g., red cell antigen genotyping series and oncology/cardiac panels) shown in the policy.

• Red cell antigen genotyping series examples include codes 0180U–0192U with specified gene/exon targets.
• Placement/implant device codes (0220U/0221T) and other extended entries are listed with dates—bill accordingly.

Use listed oncology genomic profiling U-codes and follow specimen/gene-count notes

Report comprehensive oncology genomic profiling and targeted tumor panels using the oncology U-codes listed in the policy and follow the test descriptors (e.g., gene counts, specimen types).

• Examples: 0244U (257-gene comprehensive oncology profiling), 0250U (505-gene targeted genomic sequence panel), 0257U–0259U series.
• Observe specimen requirements (FFPE tumor tissue or plasma) and effective/reference dates when ordering and billing.

Bill molecular/genomic tests with the specified U-code listings and specimen notes

Use the policy's molecular/genomic test code listings and descriptions (e.g., 0362U–0364U) for molecular oncology and specialty tests; follow specimen and algorithm notes provided.

• 0362U: targeted hybrid capture RNA sequencing (82 content + 10 housekeeping genes) for thyroid cancer—FNA or FFPE specimen.
• 0363U/0364U: ddPCR and multiplex PCR/NGS MRD testing descriptions and their reported algorithmic outputs—use the listed codes when ordering/billing.

Verify and use temporary/new CPT/HCPCS (T/U) codes and effective dates when billing

Follow the additional code entries and activation/effective dates for recently added T/U codes when submitting claims for these services; the policy lists many temporary/new codes with dates.

• Examples include 0398U (Barrett's esophagus methylation analysis), 0403T/0403U, 0478U, 0481U and many codes with 2023–2025 activation dates.
• Verify the code descriptor and effective/activation date in the policy before billing.

Bill Category III/T-codes and other temporary codes exactly as listed

Use the policy's temporary and Category III code listings for emerging technologies and procedures; bill using the exact T-code descriptors where applicable.

• Category III examples: 0588T–0590T (neurostimulation system/programming), 0591T–0593T (health coaching), 0599T (fluorescence wound imaging).
• Follow the descriptors and effective dates when reporting these services.

Use 0599T and related fluorescence imaging codes with listed descriptors

Fluorescence wound imaging procedures must be billed with the listed codes (e.g., 0599T) and the policy's descriptor for the imaging session.

• 0599T: real-time fluorescence wound imaging per session; list separately for additional anatomic sites as described.
• Use the effective date and descriptor when documenting and billing.

Bill device implantation/programming/interrogation using the listed CPT/T-codes

Device implantation, programming, and interrogation services must be billed using the listed device and programming codes and follow parameter thresholds where specified.

• Examples include 0646T–0671T series for device implantation and 0589T/0590T for neurostimulation programming (1–3 parameters vs 4+ parameters).
• Follow code descriptors and effective dates when submitting claims.

Report amblyopia remote treatment with 0704T–0705T as listed

Amblyopia remote treatment services must be billed with the listed Category III codes (0704T–0705T) for device supply, set-up, and surveillance services.

• 0704T: device supply with initial set-up and patient education; 0705T: surveillance center technical support with minimum training hours per period.
• Use the effective dates shown in the policy when billing.

Use listed Category III codes for cardiac focal ablation and related procedures

Cardiac focal ablation using radiation therapy and related Category III codes must be billed with the listed T-codes and descriptors.

• Examples: 0745T–0747T for noninvasive arrhythmia localization, treatment planning, and delivery.
• Follow listed effective dates and descriptors when ordering and billing these services.

Bill supplies/devices with the listed HCPCS/C-codes and effective dates

Supply and device HCPCS/C-codes should be used as listed in the policy for device/supply billing; confirm the code descriptor and effective date before submission.

• Examples include A4238 (CGM supply allowance), C1747 (single-use endoscope), C2624 (implantable pulmonary artery pressure sensor).
• Check per-code effective dates (shown alongside each HCPCS/C-code in the policy).