Blue Cross Blue Shield - Texas Prior Authorization Lookup
- Blue Cross Blue Shield - Texas timely filing
- Blue Cross Blue Shield - Texas coverage criteria
- All Blue Cross Blue Shield - Texas policy updates
Latest Blue Cross Blue Shield - Texas prior authorization updates25
- Prior AuthClinical/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
- Prior AuthClinical/Medical PolicyEff. 2025-10-012025 Drug List (Pharmacy Benefit) — Formulary and Utilization ManagementLists covered prescription and specialty drugs for Blue Cross and Blue Shield of Texas pharmacy benefit members, including tiers and utilization management (prior authorization, step therapy, quantity limits), and provider/member resources.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-04-05Prior Authorization Requirements for Medicare Advantage Medical, Surgical and Behavioral Health ServicesThis document governs prior authorization, notification, and medical necessity requirements for Medicare Advantage members and providers contracting with Blue Cross and Blue Shield of Texas; it describes which services require prior authorization, network/notification rules, and how to request authorizations.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-04-01MAPD Prior Authorization Procedure Code List — Prior Authorization and Documentation RequirementsA procedural code list and associated preauthorization and documentation requirements for services that may require prior authorization under the MAPD benefit; intended for providers submitting claims to Blue Cross Blue Shield - Texas and for eviCore-managed codes.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-04-01Prior Authorization Requirements for Blue Cross Medicare Advantage (Texas)Defines prior authorization and notification requirements for Blue Cross Medicare Advantage members in Texas, including services managed via eviCore and Blue Cross and Blue Shield of Texas; affects network and out-of-network providers and members covered under the Medicare Advantage plans.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-012025 Commercial Prior Authorization Codes for Administrative ServicesGoverns the list of CPT/HCPCS codes and associated administrative prior authorization requirements and management contacts for commercial members (including TDI-identified fully insured members) effective 01/01/2025. Affects providers submitting prior auth requests and internal utilization management teams.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-012025 Recommended Clinical Review, Post-Service Review and Non-Covered Procedure Code List (ASO)Administrative code list describing procedure code groupings (Recommended Clinical Review, Post-Service Review, Non-Covered, Experimental/Unproven, Unlisted) and effective dates for Administrative Services Only (ASO) contracts, used to guide utilization management and prior authorization for Blue Cross Blue Shield - Texas.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-012025 Recommended Clinical Review; Post-Service Review and Non-Covered Procedure Code List (Plastic/Reconstructive Surgery)Lists procedure codes in plastic/reconstructive surgery and related services that are subject to medical policy review, recommended clinical review, prior authorization, non-coverage, or classified as experimental for Blue Cross Blue Shield - Texas members.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-012026 Commercial Prior Authorization Codes for Administrative Services OnlyList of CPT/HCPCS codes and service categories for which prior authorization may be required for Blue Cross Blue Shield of Texas commercial administrative services; intended for providers and administrative staff who submit prior authorization requests.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01Commercial Prior Authorization Codes for Administrative ServicesLists CPT and HCPCS codes for which prior authorization may be required for Blue Cross Blue Shield of Texas commercial members, describes vendor routing and how providers should submit requests; coverage depends on member benefits.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01MAPD Prior Authorization Procedure Code List (Plastic/Reconstructive Surgery)A procedure-code list specifying CPT/HCPCS codes that require benefit preauthorization (or are managed) for MAPD members; intended for providers and utilization management staff to determine prior authorization and documentation requirements.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medical/Surgical Procedures Requiring Prior Authorization — Advanced Imaging, Molecular Genetic Testing, Transport and Surgical ProceduresList of CPT/HCPCS codes and associated prior authorization management for advanced imaging/radiology services for Blue Cross Blue Shield of Texas fully insured and certain ASO groups; indicates services that may require prior authorization and which vendor manages authorization.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Pa Codes Fully Insured Certain Aso 01012026 TxPart 1 of a multi-part Blue Cross Blue Shield Texas list of CPT/HCPCS codes associated with services/categories for which prior authorization may be required for Fully Insured and certain ASO accounts; includes managing entity (Carelon) and effective/updates notes for some codes.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01Prior Authorization Services for Fully Insured & Certain Administrative Services GroupsDefines prior authorization requirements and vendor routing for fully insured and certain administrative services groups of Blue Cross Blue Shield of Texas, including which services require authorization and where providers should verify requirements.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01Prior Authorization Services for Other Administrative Services Only (ASO) MembersThis policy describes prior authorization processes and services that require prior authorization for Blue Cross Blue Shield of Texas ASO members and guides providers on verification and clinical review processes.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/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
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Prior Authorization requirements for Medicare Advantage servicesDefines prior authorization, notification, and medical necessity requirements for Medicare Advantage medical, surgical, and behavioral health services for Blue Cross and Blue Shield of Texas members; affects in-network and out-of-network providers serving BCBSTX Medicare Advantage members.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Prior authorization and vendor routing for advanced imaging and molecular genetic testingLists 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.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Recommended Clinical Review, Post-Service Review and Non-Covered Procedure Code List (Plastic/Reconstructive Surgery subset)This document lists procedure codes used by Blue Cross Blue Shield - Texas that are subject to medical policy review categories (MP Criteria), recommended clinical (predetermination) review, post-service review, unlisted classifications that may require prior authorization, or codes designated as not covered/experimental; it affects providers submitting claims for the listed procedures.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-01-012024 Commercial Prior Authorization Codes for ASO (partial list)List of CPT and HCPCS codes and service categories for which prior authorization may be required for Blue Cross Blue Shield of Texas commercial plans; identifies managed-by entity (Carelon) and provides initiation methods for authorization requests. Affects providers seeking prior authorization for listed services.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-01-012024 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.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2024-01-01MAPD Benefit Prior Authorization Procedure Code List (prior authorization and documentation requirements)A searchable list of CPT and HCPCS procedure codes for which prior authorization may be required for MAPD members of Blue Cross and Blue Shield of Texas; informs providers about codes that may trigger prior authorization and required supporting documentation.All Blue Cross Blue Shield - Texas updates
- Prior AuthClinical/Medical PolicyEff. 2024-01-01Prior Authorization Requirements for Outpatient and Select ServicesThis document lists services and service categories that require prior authorization for fully insured and certain ASO groups of Blue Cross Blue Shield of Texas; it affects providers submitting authorization requests and verifying benefits. It covers outpatient medical/surgical services, select specialty services, home-based services, mental health/substance use disorder services, and pharmacy/administered drug reviews.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-01-01Prior Authorization Services for Other Administrative Services Only (ASO) MembersDefines prior authorization requirements, review processes, and services that require authorization for ASO accounts of Blue Cross Blue Shield of Texas; applies to providers treating ASO members and administrative staff managing authorization workflows.All Blue Cross Blue Shield - Texas updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-01-01Prior Authorization rules Medicare Advantage Medical Surgical/Behavioral HealthGoverns prior authorization, notification, and medical necessity requirements for Blue Cross and Blue Shield of Texas Medicare Advantage members for medical, surgical, and behavioral health services; applies to in-network and out-of-network providers as specified.All Blue Cross Blue Shield - Texas updates
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Tool Description
Search Blue Cross Blue Shield - Texasprior 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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