Prior Authorization Changes for Some Commercial and Government Program Members

June 29, 2026

We’re changing prior authorization requirements that may apply to some commercial and government program 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 BCBSOK and EviCore healthcare. Carelon Medical Benefits Management and Alacura Medical Transportation Management will review utilization management and related services for some commercial members.

These changes for commercial members begin Oct. 1, 2026:

  • Addition of radiology advanced imaging codes to be reviewed by Carelon
  • Addition of molecular genetic lab testing codes to be reviewed by Carelon
  • Removal of molecular genetic lab testing codes previously reviewed by Carelon
  • Addition of medical oncology codes to be reviewed by Carelon
  • Addition of drug codes to be reviewed by BCBSOK

These changes for Medicare Advantage members begin Aug. 1, 2026:

  • Our Part B Step Therapy Program will now begin
  • Removal of miscellaneous codes previously reviewed by BCBSOK
  • Addition of miscellaneous codes to be reviewed by BCBSOK

These changes for Medicare Advantage members begin Oct. 1, 2026:

  • Miscellaneous changes to the Part B Step Therapy Program

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 2025 AMA. 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. Alacura Medical Transportation Management, LLC. is an independent company that has contracted with BCBSOK to provide utilization management services for participants with coverage through BCBSOK.

BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. oducts and services they offer.