Nov. 24, 2025
We’re changing prior authorization requirements that may apply to Medicare Advantage members.
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 code changes from the Centers for Medicare & Medicaid Services.
For some services and members, prior authorization may be required through Blue Cross and Blue Shield of Oklahoma. Utilization management and related services for members with Medicare Advantage will be reviewed by Evicore healthcare. Carelon Medical Benefits Management will review utilization management and related services for some commercial members.
These changes for members of Medicare Advantage begin Jan. 1, 2026:
- Removal of lab codes previously reviewed by Evicore
For a revised list of codes, refer to prior authorization lists.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
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 coverage contract or guide. If you have any questions, call the number on the member's ID card.
Services performed without required prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2024 AMA. All rights reserved. CPT is a registered trademark of the AMA.
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. EviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSOK. Carelon Medical Benefits Management is an independent company that has contracted with BCBSOK to provide utilization management services for members with coverage through BCBSOK.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.