2024 Commercial Prior Authorization Codes for Fully Insured & Certain Administrative Services (ASO Groups)
Lists CPT and HCPCS codes and service categories that may require prior authorization for BCBSTX commercial fully insured and certain ASO groups; describes authorization request methods and indicates many services are managed by Carelon.
Multiple new molecular genetic lab test codes (e.g., 0368U, 0378U, 0379U, 0380U, 0388U, 0389U, 0391U, 0392U, 0396U, 0400U, 0401U, 0405U, 0409U, 0410U, 0411U, 0413U, 0414U, 0417U, 0420U, 0422U, 0423U, 0424U, 0425U, 0426U, 0428U, 0433U, 0434U, 0437U, 0438U, 0439U, 0440U, 0444U, 0448U, 0449U) were added with Carelon mapping and effective dates.
Several tests include specific test descriptions such as minimal residual disease assays, drug metabolism panels including CYP2D6 deletion/duplication, targeted genomic panels (e.g., 523-gene, 361-gene), and specialized oncology and psychiatric panels.
Many codes are explicitly marked 'Carelon = Carelon' indicating internal mapping to Carelon review or management.
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