Baylor Scott & White Health Plan Prior Authorization Lookup
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Latest Baylor Scott & White Health Plan prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Atidarsagene autotemcel (Lenmeldy) — Medical Coverage PolicyDefines coverage and prior authorization requirements for atidarsagene autotemcel (Lenmeldy) for treatment of metachromatic leukodystrophy (MLD) in pediatric patients; applies when member benefits include the drug per plan documents.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Lovotibeglogene autotemcel (Lyfgenia) — Medical Coverage PolicyDefines medical necessity and prior authorization requirements for one-time administration of lovotibeglogene autotemcel (Lyfgenia) for members with sickle cell disease, including eligibility, exclusions, and coding guidance; applies to Baylor Scott & White Health Plan lines of business.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Psychological TestingDefines medical necessity, coverage limits, coding, and prior authorization rules for psychological, neurobehavioral, and neuropsychological testing across Baylor Scott & White Health Plan lines of business.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Cancer Chemotherapy / Therapy GuidelinesDefines medical necessity and coverage criteria for oncology medications and select related therapies for Baylor Scott & White Health Plan members, including criteria for FDA-labeled and compendium-supported uses and requirements for continuation and prior authorization.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-06-01Commercial Prior Authorization / Notification List (partial)Lists CPT/procedure codes requiring prior authorization or notification for BSWHP commercial products; explains portal submission and benefit verification requirements; affects network providers submitting authorization requests for commercial members.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Endoscopic Surgery for CraniosynostosisDefines medical necessity and prior authorization requirements for endoscopic (endoscopy-assisted) surgical repair of craniosynostosis in infants, and lists applicable procedure and diagnosis codes. Applies to Baylor Scott & White Health Plan lines of business and referenced Medicare/Medicaid guidance.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Exagamglogene autotemcel (Casgevy) coverage and prior authorizationMedical coverage policy governing prior authorization and medical necessity criteria for exagamglogene autotemcel (Casgevy) for treatment of Sickle Cell Disease (SCD) and Transfusion-dependent β-thalassemia (TDT) for Baylor Scott & White Health Plan members.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Nerve Graft with Radical ProstatectomyThis policy governs prior authorization and coverage determinations for unilateral or bilateral nerve grafting performed with radical prostatectomy for erectile dysfunction, and applies to Baylor Scott & White Health Plan members unless superseded by plan documents or applicable Medicare/Medicaid mandates.All Baylor Scott & White Health Plan updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-06-01Prior Authorization and CPT/HCPCS Code Listing — Submission, Notification, and Coverage DeterminationGoverns prior authorization requirements, submission methods, and coverage determination for services and procedure codes for Baylor Scott & White Health Plan and its subsidiaries; applies to providers submitting authorizations and claims for members covered by the plan.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-06-01Self-funded Administrative Services Only (ASO Prior Authorization/ Notification)Lists prior authorization and notification requirements and code listings for Baylor Scott & White Health Plan acting as third‑party administrator for self‑funded (ASO) employer plans; describes provider portal submission and verification responsibilities for providers and members in Texas.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Transcatheter Valve Replacement or RepairDefines medical necessity, prior authorization, and coding guidance for transcatheter aortic, mitral and pulmonary valve replacement or repair for Baylor Scott & White Health Plan members.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Transplantation Services (Organ and Stem Cell Transplantation)Defines medical necessity, prior authorization, covered organ and stem cell transplant types, and requirements for transplant evaluation and facility contracting for Baylor Scott & White Health Plan members.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-06-01UHC Linked Plans Prior Authorization/Notification ListDefines procedures and codes that require prior authorization or notification for Baylor Scott & White Health Plan (UHC linked plans) providers and explains where to submit requests; affects providers submitting claims and seeking preauthorization for members covered by Baylor Scott & White Health Plan and its related entities.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-05-01Commercial Prior Authorization / Notification List (partial)Governs the commercial prior authorization and notification requirements for Baylor Scott & White Health Plan provider network; affects providers submitting preauthorization or notifications for services to plan members.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Genetic (Genomic) Testing Coverage CriteriaDefines medical necessity, prior authorization, documentation, and coverage criteria for genetic and genomic testing for members of Baylor Scott & White Health Plan and affiliated lines of business.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Infertility, Fertility Preservation, Assisted Reproductive TechnologyDefines medical necessity, coverage stance, and required prior authorization for infertility evaluation, fertility preservation for iatrogenic infertility (notably cancer-related), and associated assisted reproductive technology services for members of Baylor Scott & White Health Plan.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Laser Treatment of Skin LesionsDefines medical necessity, prior authorization, and coverage criteria for laser therapy for various skin lesions for Baylor Scott & White Health Plan members; applies across lines of business and references Medicare and Texas Medicaid guidance where applicable.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Medications Covered Under Medical Insurance PolicyDefines medical necessity, prior authorization expectations, and general coverage criteria for medications administered by a medical professional when no more specific medical policy exists; applies to Baylor Scott & White Health Plan lines of business and related plan types.All Baylor Scott & White Health Plan updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-05-01Prior Authorization and Prior Authorization Code ListGoverns Baylor Scott & White Health Plan prior authorization requirements, lists CPT procedure codes that require prior authorization or are on the prior authorization list, and explains verification and portal submission instructions for providers and members.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-05-01Self-funded ASO Prior Authorization/NotificationGovernance of prior authorization and notification requirements for Baylor Scott & White Health Plan acting as third‑party administrator for self‑funded (ASO) employer-sponsored plans, including how providers submit requests and that benefits vary by member plan.All Baylor Scott & White Health Plan updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-05-01UHC Linked Plans Prior Authorization/ Notification ListA prior authorization and notification code list for Baylor Scott & White Health Plan (UHC linked plans) describing services that require prior authorization or notification and guidance on where providers can submit requests; applies to providers submitting claims for plan members.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-012026 Formulary (Drug List) for BSW SeniorCare Advantage PlansThis formulary lists covered drugs, tiers, and utilization controls (prior authorization, quantity limits, step therapy, billing directives) for BSW SeniorCare Advantage Medicare Part D plans and explains how to use the formulary, change notifications, and exception/transition processes.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Commercial Prior Authorization/Notification List — Procedures and TestsDefines the list of CPT/HCPCS codes that require prior authorization or notification for Baylor Scott & White Health Plan commercial products and explains submission and benefit verification expectations for providers.All Baylor Scott & White Health Plan updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-04-01Prior Authorization / Prior Approval Code ListThis document lists codes that require prior authorization (and notes program scope and submission channels) for Baylor Scott & White Health Plan and its affiliates; it informs providers about prior authorization requirements, benefit verification, and notification requests affecting members and providers.All Baylor Scott & White Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Alglucosidase alfa (Lumizyme) for Pompe diseaseDefines prior authorization, medical necessity criteria, and renewal criteria for coverage of alglucosidase alfa (Lumizyme) for treatment of infantile- and late-onset Pompe disease for Baylor Scott & White Health Plan members.All Baylor Scott & White Health Plan updates
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Tool Description
Search Baylor Scott & White Health Planprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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