Prior Authorizations Lists

The procedures or services on these lists may require prior authorization by BCBSOK, eviCore Healthcare^® (for Blue Cross Medicare Advantage^SM Members) or Carelon Medical Benefits Management (formerly known as AIM Specialty Health) for some commercial members. These lists are not exhaustive and are not necessarily covered under the member benefits contract. Lists are updated quarterly to comply with AMA and CMS guidelines.

Consult Availity^® or your preferred vendor for eligibility and benefits.

• 2023 Commercial Code Look Up
• 2022 Commercial Code Look Up
• 2021 Commercial Code Look Up

Fully Insured, ASO and HMO Plans

Digital Lookup Tool (For Fully Insured Only)

Review categories below to find out if a member's procedure may require prior authorization.

• Medical Procedure
• Medical Drugs
• Behavioral Service

Procedure Code Lists

• 2023 Prior Authorization Requirements - Summary of Services
• 2023 Commercial Outpatient Benefit Preauthorization Behavorial Health Procedure Code List
• 2023 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List
• 2023 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
• 2023 Commercial Specialty Pharmacy Prior Authorization Drug List

• 2022 Prior Authorization Requirements - Summary of Services
• 2022 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List
• 2022 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code 
• 2022 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
• 2022 Commercial Specialty Pharmacy Prior Authorization Drug List
  
  
• 2021 Prior Authorization Requirements - Summary of Services
• 2021 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List for FI & ASO members
• 2021 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List
• 2021 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
• 2021 Specialty Pharmacy Infusion Site of Care Benefit Preauthorization Drug List

For Blue Cross Medicare Advantage Prior Authorization Requirement and Procedure Code List visit the Blue Cross Medicare Advantage page.

Predetermination, Post-Service Review and Non-Covered Code List

• 2023 Commercial Procedure Code List - Fully Insured - Recommended Clinical Review (Predetermination), Medical Necessity and Non-Covered Services
• 2022 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services
• 2021 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services

The attached lists are for reference only and are not intended to be a substitute for benefit verification or BCBSOK's medical policies. All lists above apply only to members who have health insurance through a Blue Cross and Blue Shield of Oklahoma Plan or who are covered by a group plan administered by BCBSOK. If your patient is covered under a different Blue Cross and Blue Shield Plan, please refer to the Medical Policies of that Plan.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSOK.

Carelon Medical Benefits Management is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association