Prior Authorization Required / Submission Caveats

Prior authorization is required for many services on the Baylor Scott & White Health Plan (BSWHP) prior authorization list. Registered users can submit electronic preauthorization requests via the secure provider portal. For phone submissions or assistance, call the number on the member's ID card or contact your Provider Relations Representative. Prior authorization is not a guarantee of payment; eligibility, benefit limitations, exclusions and claims agreements are verified at time of service. Newly published codes or emerging therapies not listed may still require prior authorization — check BSWHP before providing services.

• Registered users: use secure provider portal for electronic preauthorization.
• Phone submissions: call number on member ID card for assistance.
• Prior authorization ≠ guarantee of payment; benefits determined by member's plan and eligibility at time of service.
• Notification (not necessarily authorization) may be requested to assist discharge planning, care coordination, and case management.

Code Listing / Mapping (Partial)

This section contains consolidated code mappings and date/status annotations used for provider coding reference. Codes may be listed with short descriptors, mapped equivalencies (crosswalk-style), and effective/status dates. Use these entries for claims submission and to determine when codes were added or updated in the plan's listing. Presence in the list does not by itself indicate coverage — medical necessity and plan benefits still apply.

• Code entries include CPT, HCPCS, Category III (T) and temporary (U) codes with effective dates and status annotations.
• Some entries show crosswalk-like equivalencies (eg, arthrodesis/interbody mappings, arthroscopy-to-other-procedure mappings, rhinoplasty equivalencies).
• Newly published codes may require prior authorization to determine medical necessity.

Arthroscopy / Knee-Hip Mappings

Arthroscopy and joint procedure mappings: several hip arthroscopy CPT codes are cross-referenced to knee arthroscopy equivalents for coding/mapping purposes. Review effective dates when using mapped equivalencies.

• 29866–29876 mapped as arthroscopy hip → knee surgical equivalents; effective date 10/1/2018 where noted.
• 29866: mapped to knee osteochondral autograft (includes harvesting) — 10/1/2018.
• 29867: mapped to knee osteochondral allograft — 10/1/2018.
• 29868: mapped to knee meniscal transplantation — 10/1/2018.
• 29870–29875: mapped to diagnostic or specific knee arthroscopy procedures — 10/1/2018.

Rhinoplasty Mappings

Rhinoplasty mappings: selected rhinoplasty CPT codes are noted as mapped equivalencies (effective dates shown). Verify coding and medical necessity documentation for cosmetic vs reconstructive indications.

• 30400 — Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip. (mapped entry; 10/1/2018 → 1/2/2020)
• 30410 — Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip. (mapped entry; 10/1/2018 → 1/2/2020)
• 30420 — Rhinoplasty, primary; including major septal repair. (mapped entry; 10/1/2018 → 1/2/2020)

Cardiac / Transplant Mappings

Cardiac and transplant procedure mappings and status annotations are listed for provider reference. Many high-acuity cardiac/transplant CPT codes include a status/date field — confirm effective dates when requesting authorization.

• 33340 — Percutaneous transcatheter left atrial appendage closure; status/date noted (eg, 5/1/2023).
• 33361–33366 — TAVR/TAVI codes with percutaneous/open approach annotations (effective 1/2/2020).
• 33418 — Transcatheter mitral valve repair; initial prosthesis (1/2/2020).
• 33927, 33935, 33945 — Implantation/heart-lung/heart transplant codes with 1/2/2020 effective dates.
• 95940, 93799, 93597 and select U-codes listed with effective/status dates for cardiovascular and transplant-related services.

Code Listing and Date / Status Annotations

Code listings include date and status annotations (effective dates, implementation notes). Providers should reference the date/status for correct coding and to determine when codes were introduced to the plan's listing.

• Examples: 53450–53454 and related urology codes include 1/1/2024 or 5/1/2023 dates as noted.
• 61736–61737 (LITT) effective 5/1/2023.
• 62360–62380 intrathecal/epidural device codes annotated to spine procedure equivalencies and 10/1/2018 where shown.
• 64454, 64479–64484 nerve injection and related codes with 10/1/2018 effective dates; 64454 updated 1/1/2023.
• 74150/74160 CT abdomen codes effective 8/1/2018.
• CPT Category III (T) and temporary (U) codes with varied effective dates (examples throughout section).

Intrathecal / Epidural Drug Infusion Device Codes

Intrathecal/epidural drug infusion device and pump procedure codes are cross-referenced to spine procedure equivalencies. Verify device implantation/replacement coding and associated spine procedure mappings when submitting authorizations or claims.

• 62360–62380 series include implantation or replacement of intrathecal/epidural drug infusion devices (programmable pumps) mapped to spine decompression/laminectomy procedure codes.
• 62380 example: implantation or replacement of programmable pump mapped to endoscopic decompression of spinal cord, 1 interspace — effective 10/1/2018.
• Use mappings to ensure appropriate primary procedure coding and to identify any add-on or separate listing requirements.

CPT Code Listing — Imaging & Interventional Procedures

Imaging and interventional procedure CPT listings (radiology, nuclear medicine, interventional radiology, therapeutic radiology) are included for reference. No separate authorization instructions appear within many of these listed code excerpts — check the portal for specific prior authorization rules.

• CT, MRI, and interventional radiology CPT codes such as 74150/74160 (CT abdomen) with dates noted.
• Brachytherapy and radionuclide procedure entries (eg, 77790, 77799) with 10/1/2021 dates.
• Nuclear medicine thyroid imaging codes (eg, 78012–78016) cross-listed with effective dates (8/1/2018).

Coding Reference (No Authorization Instructions in Excerpt)

Coding reference excerpts are provided for claims submission and provider coding orientation. Many listed codes are informational in the excerpt and may not carry explicit prior authorization directions within the text — providers must verify requirements via the provider portal.

• Examples include nuclear medicine, lab molecular/genetic (CPT/HCPCS U-codes), and oncology-related temporary codes with descriptors and dates.
• Genetic/molecular test codes (81202–81425, etc.) with effective dates for laboratory billing reference.
• Category III (T) codes and proprietary U-codes are included as informational entries across this section.

CPT/HCPCS Code Descriptors and Effective Dates

CPT/HCPCS code descriptors and effective dates are listed throughout the code blocks. Use the effective dates to determine when codes became active in the plan listing and to support prior authorization timing.

• 81233, 81237–81247 series (genetic tests) with dates such as 10/1/2021 and 1/2/2020.
• 0003U–0008U and 0088U–0092U series (U-codes) with 1/1/2023 effective dates for many entries.
• 0309U–0316U and 0398U–0406U listed with effective dates through 5/1/2023 and 10/1/2023 for selected tests.

Code Descriptions and Dates

Code descriptions and dates for specialized procedures (cardiovascular, diagnostic assays, oncology panels, and others) are included with short clinical descriptors. Providers should use these entries to align test names, CPT/U-codes, and effective dates when completing prior authorization requests.

• 93597, 93799 and related cardiovascular entries with dates and short descriptors.
• 0003U–0008U: oncology and laboratory assay U-codes with 1/1/2023 effective dates.
• 0088U–0092U: transplant and oncology gene expression profiling U-codes with cross-references and date annotations.

Continued Code Listings

Continued code listings include cardiac/transplant, oncology U-codes, genetic testing CPTs, Category III (T) procedures, and a broad set of HCPCS supply and drug codes. These are informational and should be cross-checked in the portal for coverage/authorization rules.

• 0411T–0419T and related T/U entries for cardiac contractility modulation and device procedures (1/1/2023 effective dates where noted).
• 0523T–0527T series (intraprocedural and implantable monitoring systems) effective 1/1/2023.
• 0603T–0607T and 0634T–0640T Category III codes for imaging and device monitoring with 1/1/2023 effective dates.
• Extensive genetic and genomic CPT codes (812xx, 813xx, 814xx) with 1/2/2020 effective dates for many entries.
• HCPCS A-codes (A0435–A9607) with effective dates through 2025 and 2026 for selected supply and drug items.

Code List Excerpt — No Authorization Statements

Some code list excerpts are informational only and do not include explicit authorization instructions in the source text. Always verify via the provider portal whether a specific code requires prior authorization or notification.

• 74150/74160 CT abdomen entries appear without direct authorization instructions in the excerpt — verify portal rules.
• Many temporary U-codes and T-codes are presented as reference entries; check plan site for authorization rules.
• Presence on the list may be for information and not imply coverage.

Code List — Informational

Several code groups are informational and intended to guide coding and billing. Use the plan portal or provider relations for interpretation of coverage status, step therapy, or quantity limits.

• Category III (T) codes (0776T–0791T, 0804T–0810T, etc.) with dates and descriptors for new technologies and services.
• Large panels of genetic testing CPTs (81202–81425, 81415, 81425) and HCPCS supply codes (A-codes) listed for reference.
• Some HCPCS drug/supply codes (A9513, A9517, A9606, etc.) include recent effective dates (2025–2026).

Device / Procedure Code Entries & Add-on Instructions

Device and procedure entries, including cardiac contractility modulation systems, intracardiac monitors, remote monitoring setup/reporting services, and add-on intraprocedural codes, are present with instructional notes (eg, 'List separately in addition to code for primary procedure'). Confirm whether these codes require separate authorization or are billed as add-ons.

• 0411T–0419T: insertion, removal, programming, interrogation, and related device services for cardiac contractility modulation systems (1/1/2023).
• 0523T: intraprocedural coronary FFR with 3D mapping — 'List separately in addition to code for primary procedure' (0523T, 1/1/2023).
• 0524T–0527T: intracardiac monitoring system insertion/replacement codes (1/1/2023).
• 0607T–0608T and related codes: remote monitoring/setup, education, data analysis and transmission services; check separate billing and authorization rules.