April 3, 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.
Changes are:
- July 1, 2025 − Addition of genetic testing codes to be reviewed by Carelon Medical Management
- July 1, 2025 − Replacement of medical oncology codes to be reviewed by Carelon Medical Management
- July 1, 2025 − Addition of medical oncology codes to be reviewed by Carelon Medical Management
- July 1, 2025 − Removal of specialty drug codes previously reviewed by Blue Cross and Blue Shield of Oklahoma
- July 1, 2025 − Addition of specialty drug codes to be reviewed by BCBSOK
More information: Visit Carelon provider information or our prior authorization code lists.
Important reminder: 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 benefit information 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 American Medical Association. 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.
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.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.