June 27, 2025
We’re 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 changes from the Centers for Medicaid & Medicare 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 some commercial members will be reviewed by Carelon Medical Benefits Management.
Here is a summary of changes, effective Oct. 1, 2025:
- Addition of genetic testing codes to be reviewed by Carelon
- Addition of a musculoskeletal code to be reviewed by Carelon
- Replacement of medical oncology drug codes reviewed by Carelon
- Addition of medical oncology codes to be reviewed by Carelon
- Removal of a drug therapy code previously reviewed by BCBSOK
- Addition of various drug codes to be reviewed by BCBSOK
For more information, visit Carelon provider resources. For a revised list of codes, refer to our prior authorization code list.
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 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 2024 AMA. All rights reserved. CPT is a registered trademark of the AMA.
Carelon Medical 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.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.