Blue Cross and Blue Shield of Texas - Medicare Provider Resources
Providers should contact EviCore to obtain Pre-Certifications for services listed below. Services performed without a pre-authorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
As of 5/01/2024, EviCore will no longer provide authorization for BCBS TX Medicaid Members. If you need prior authorization for services scheduled after May 1, 2024, call the number on the member ID card.
Medical Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSTX.com for a list of codes that require authorization through BCBSTX as of 1/1/2024. If you have any questions, please contact BCBSTX using the number on the back of the member’s ID card.
Radiation Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSTX.com for a list of codes that require authorization through BCBSTX as of 1/1/2024. If you have any questions, please contact BCBSTX using the number on the back of the member’s ID card.
Medicare Membership:
Blue Cross Medicare Advantage (HMO) SM
Blue Cross Medicare Advantage (PPO) SM
Texas Individual Medicare HMO
Texas Individual Medicare PPO
Texas Group Medicare PPO
Obtain Authorization for:
Ultrasounds do not require pre-authorization as of 7/1/2023. Should you have any questions, please contact BCBSTX using the number on the back of the member's ID card. Please see the code lists located at evicore.com for codes managed by EviCore.
BCBSTX Medicare: Effective 9/1/2019, ST, OT, PT, Chiropractic and Cardiology services are no longer in scope for management by EviCore. Please see the code lists located at evicore.com for codes managed by EviCore.
Lab Management Solutions-Molecular and Genomic Lab Testing
Musculoskeletal Services
Joint Surgery (Outpatient/Inpatient)
Spine Surgery (Outpatient/Inpatient)
Interventional Pain (Outpatient)
Outpatient Advanced Radiology Imaging
Outpatient Sleep
Outpatient Specialty Drug
Musculoskeletal
Radiology
Sleep
Laboratory Management
Medical Specialty Drugs
Need Help?
Registration Instructions
EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider
Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.