June 30, 2025
We’re changing prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes due to updates from utilization management or the American Medical Association.
Utilization management and related services for Medicare Advantage members will be reviewed by EviCore healthcare.
Here is a summary of changes, effective Oct. 1, 2025:
- Removal of musculoskeletal codes previously reviewed by EviCore
- Removal of specialty drug code previously reviewed by EviCore
- Addition of specialty drug codes to be reviewed by EviCore
- Addition of lab codes to be reviewed by EviCore
For a complete and up-to-date list of codes, refer to utilization management.
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.
CPT copyright 2024 AMA. All rights reserved. CPT is a registered trademark of the AMA.
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.
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 Blue Cross and Blue Shield of Oklahoma.
EviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.