Prior Authorization Codes Updated for Commercial Members, Effective Jan. 1

What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is 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 (HCPCS) changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.

Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Changes are:

· Jan. 1, 2023 – Removal of Orthopedic Musculoskeletal codes previously reviewed by BCBSOK

· Jan. 1, 2023 – Code list will be updated Jan. 1, 2023 to include codes for the existing PA Transplant Category. There is no change to BCBSOK’s PA requirements.

· Jan. 1, 2023 – Replacement of a Specialty Pharmacy code reviewed by BCBSOK

· Jan. 1, 2023 – Removal of Outpatient Surgery-Obesity codes previously reviewed by BCBSOK

· Jan. 1, 2023 – Removal of Behavioral Health codes previously reviewed by BCBSOK

· Jan. 1, 2023 – Replacement of Behavioral Health codes reviewed by BCBSOK

· Jan. 1, 2023 – Removal of Molecular Genetic Testing codes previously reviewed by AIM

Training Reminder:

Contact your Network Representative for additional training on using the AIM Specialty Health ProviderPortal.

More Information: For a revised list of codes, go to our provider website in the preauthorization section.

CPT copyright 2021 American Medical Association (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.

AIM Specialty Health (AIM) 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.