Prior Authorization Code Updates for Medicare Members, Effective Jan. 1, 2025

We’re changing prior authorization requirements for Blue Cross Medicare Advantage members to reflect new, replaced or removed codes, including:

• Removal of medical oncology and supportive care codes previously reviewed by eviCore^®
• Medical oncology drug codes previously reviewed by eviCore to be reviewed by BCBSTX

Reminder: Medical Transportation Utilization Management Via Alacura Effective Jan. 1, 2025

Review information related to medical transportation prior authorization and recommended clinical review via Alacura effective Jan. 1. Register for free training sessions.

Notification of Annual Benefit Updates

BCBSTX annually updates member files with benefit changes. As always, we encourage you to obtain your eligibility and benefit information using Availity^® or your preferred electronic vendor. In the event you need to contact BCBSTX Provider Customer Service, please recognize that hold times may be longer than normal at the beginning of the year. Deferring eligibility and benefit information requests to a later date is appreciated for patients who are not scheduled for appointments.

Clinical Payment and Coding Policy Updates

Our website’s Clinical Payment and Coding Policies 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 and does not address all reimbursement-related issues. We may add and modify clinical payment and coding policies. The following policies were added or updated:

• Annual Review: CPCP029 Medical Record Documentation Updated 
• CPCP036 Paravertebral Facet Injection Procedure Billing & Coding Policy Updated Effective 02/13/2025
• CPCP008 Psychological and Neuropsychological Testing Updated Effective 02/13/2025 
• CPCP020 Drug Testing Clinical Payment and Coding Policy Updated Effective 02/13/2025 
• CPCP011 Applied Behavior Analysis – Effective 02/01/2025