Prior authorization and vendor routing for advanced imaging and molecular genetic testing
Lists CPT/HCPCS codes and service categories for which prior authorization may be required for Blue Cross Blue Shield of Texas members; affects providers requesting authorization for advanced imaging and related services. Applies to services managed by Carelon and other named vendors as indicated.
Effective 01/01/2025, addition of site of care to the medical necessity criteria for multiple advanced imaging CPT codes.
Update Category name from 'Non-Emergent Air Ambulance' to 'Medical Transportation' and changed services management from BCBSTX to Alacura for selected codes (with an exception for TRS Fully Insured Account: 212824 through 5/22/25).
Multiple U-codes (0575U, 0576U, 0578U, 0582U, 0583U, 0585U, 0586U, 0592U, 0597U) and other molecular/genetic test codes are assigned to Alacura/Carelon for management with effective add dates (e.g., Add effective 1/1/2026).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.