Blue Cross Blue Shield - Texas Coverage Criteria
- Blue Cross Blue Shield - Texas prior authorization
- Blue Cross Blue Shield - Texas timely filing
- All Blue Cross Blue Shield - Texas policy updates
Latest Blue Cross Blue Shield - Texas coverage criteria updates10
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-07Hepatitis TestingDefines reimbursement and coverage criteria for laboratory testing related to hepatitis A, B, C, D (and related viral diagnostics) for Blue Cross Blue Shield of Texas members and providers ordering those tests.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-10-012025 Drug List (Pharmacy Benefit) — Formulary and Coverage CriteriaGoverns the pharmacy drug list for Blue Cross and Blue Shield of Texas members, describing covered drugs, tiers, specialty drug handling, and processes for exceptions, prior authorization, step therapy, and limits. Affects members, prescribing providers, pharmacies, and specialty pharmacy partners.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-10-012025 Drug List (Pharmacy Formulary) — Coverage CriteriaThis document is Blue Cross and Blue Shield of Texas' 2025 Drug List describing covered pharmacy drugs, tier placement, special requirements (PA, ST, QL, ACA), specialty drug processes, and member/provider instructions. It applies to BCBSTX members and their prescribing providers.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-09-25Diagnostic Testing of InfluenzaDefines reimbursement and laboratory coverage criteria for influenza diagnostic tests for Blue Cross Blue Shield of Texas members, including which tests are reimbursable for symptomatic and asymptomatic individuals and related coding guidance.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-09-05Allergen TestingReimbursement and coverage criteria for in‑vitro and related laboratory allergen testing for Blue Cross and Blue Shield of Texas members; applies to providers submitting claims for allergen testing under the plan(s).All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-01Pathogen Panel TestingOutpatient laboratory reimbursement and coverage criteria for multiplex molecular pathogen panel testing; affects providers submitting outpatient lab claims for multiplex PCR and other molecular pathogen panels.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-05-15Hepatitis TestingGoverns reimbursement and coverage criteria for laboratory testing for hepatitis A, B, C, and D, including which tests may be reimbursable and clinical situations that justify testing.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Nerve Fiber Density Testing (ENFD) — Skin BiopsyDefines reimbursement and coverage criteria for epidermal nerve fiber density measurement from skin biopsy to diagnose small-fiber neuropathy for Blue Cross and Blue Shield of Texas members.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Prior Authorization and Medical Necessity Updates for Advanced Imaging, Molecular Genetic, and Related ServicesLists CPT/HCPCS/temporary codes for advanced imaging, molecular genetic, and selected procedure categories that may require prior authorization, describes managed-by assignments (Carelon, Alacura), and notes addition of site-of-care to medical necessity criteria effective 01/01/2025.All Blue Cross Blue Shield - Texas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Urine Culture Testing for BacteriaPolicy governing reimbursement and clinical coverage criteria for urine culture testing (including isolate identification and antibiotic susceptibilities) for Blue Cross and Blue Shield of Texas members; affects ordering providers and laboratories performing urine cultures.All Blue Cross Blue Shield - Texas updates
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Tool Description
Search Blue Cross Blue Shield - Texas coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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