August 2023
Prior Authorization Codes Updated for Commercial Members, Effective Oct. 1, 2023
What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements that may apply to some commercial members to reflect new, replaced or removed codes. These changes are based on updates from Utilization Management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System (HCPCS) changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.
Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Changes are:
- Oct. 1, 2023 – Addition of Specialty Pharmacy codes to be reviewed by BCBSOK
- Oct. 1, 2023 – Removal of a Radiation Oncology drug code previously reviewed by Carelon Medical Benefits Management (Carelon)
- Oct. 1, 2023 – Addition of a Musculoskeletal joint and spine code to be reviewed by Carelon
- Oct. 1, 2023 – Replacement of Genetic Testing codes reviewed by Carelon
General Training Reminder: For additional training, visit the Carelon ProviderPortal.
More Information: For a revised list of codes, go to our provider website in the prior authorization section.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
CPT copyright 20222 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Carelon Health Benefits Management (Carelon) is an independent company that has contracted with BCBSOK to provide utilization management services for members with coverage through BCBSOK.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK.