Updated Prior Authorization Codes for Medicare Advantage  |  view in Web Browser


Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

November 2022


Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

COVID-19 News and Updates
Update to Prior Authorization Codes for Medicaid Members, Effective Jan. 1, 2023
Delivering Quality Care – Managing Diabetes
Delivering Quality Care – Blood Pressure Screening


MyBlue HealthSM Network Expansion

Effective Jan. 1, we will expand the MyBlue Health network to Cameron and Hidalgo (the Valley service area), Collin, Denton, Tarrant (Dallas service area) and El Paso counties.

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As a reminder, on Jan. 1, 2023, approximately 30,000 retirees from the University of Texas System (UTS) will become members of UT CARE Medicare PPO (UT CARE). UT CARE is our open access Medicare Advantage PPO plan for UTS retirees.

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Diabetes and Depression

Because there are numerous considerations for people living with diabetes – such as medication management, managing multiple comorbidities and monitoring their blood glucose – diabetics are at risk of developing psychological conditions. Help empower your patients to manage their care.

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Provider Depression Disorder Prescribing

Proper treatment of depression has been proven to effectively reduce symptoms, and decrease relapses, emergency department visits and hospitalization rates. Screening should utilize evidence-based tools to ensure accurate diagnosis, efficient treatment and appropriate follow-up. Leveraging telemedicine for mental health may allow an otherwise reluctant member to receive desperately needed care, reduce health disparities and resolve treatment gaps.

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Kidney Health Evaluation for Patients with Diabetes

We’re providing tips to consider when evaluating the kidney health of patients with diabetes.

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Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies on our website describe payment rules and methodologies for CPT, HCPCS and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It is not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process. The following policy was added or updated:

CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services UpdateAdobe Acrobat Icon – Effective 1/1/2023


Continuity of Care is Driven by Prompt Communication Upon Hospital Discharge

We’re providing important information to help you when discharging Federal Employee Program® (FEP®) members after inpatient hospital stays.

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Keeping an Eye on Improved Provider Collaboration

Communication between providers is key to positive outcomes for patients. Since many PCPs refer their patients with diabetes to eye care specialists for exams, it’s important that the specialists routinely and promptly share results with the referring PCPs.

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To support quality care, we provide information to providers and members to encourage discussions on health topics. Watch for more on health care quality in our website’s News and Updates section and on our Wellness Can’t Wait web page.

Diabetes Screening for People Using Antipsychotic Medications

According to the NCQA, people with serious mental illness who use antipsychotic medications are at increased risk of diabetes. As such, we’re providing tips to help close gaps in care for this population.

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Importance of Early and Timely Intervention for Pre- and Post-Partum Care to Help Improve Health Outcomes

Review information about the importance of communication between health care professionals and their patients during a patient’s pre-pregnancy, pregnancy and postpartum journey.

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Chiropractor Medicare Physician Fee Schedule Increase for Medicare Advantage PPOSM

Effective Jan. 1, 2023, we will implement an increase in the maximum allowable fee schedule for some procedure codes.

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Update Prior Authorization Codes for Medicare Advantage Effective Jan. 1, 2023

We are changing prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes, including:

Addition of sleep drug codes to be reviewed by eviCore®
Addition of a radiation oncology code to be reviewed by eviCore
Addition of specialty drug codes to be reviewed by eviCore
Addition of prior authorization codes to be reviewed by BCBSTX
Removal of prior authorization codes previously reviewed by BCBSTX
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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2022 – Part 2

Review important pharmacy benefit reminders, drug list updates and Utilization Management program changes.

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Prior Authorization Exemption Status via Availity® Essentials

As a reminder, due to our implementation of Texas House Bill 3459 for Prior Authorization (PA) Exemption(s), providers who have met the criteria to be reviewed for PA exemption(s) for particular services are able to check their status online via Availity as of Oct. 1, 2022.

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Regulatory & Requirements

This section includes additional items related to regulatory requirements and operational processes to assist provider offices with servicing our members. Access this month’s articlesAdobe Acrobat Icon.

We are required to provide certain notices in all published correspondence with health care providers. For the latest updates, visit the News and Updates section on the BCBSTX provider website.

Printable PDF

View a printable PDF Adobe Acrobat Icon of the non‑Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Verify and Update Your Information

Verify your directory information every 90 days. Use the Provider Data Management feature on Availity® or our Demographic Change Form. You can also use this form to submit email addresses for you and your staff to receive the Blue Review each month.


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Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation,
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