Prior Authorizations Lists

The procedures or services on these lists may require prior authorization by BCBSOK, eviCore Healthcare^® (for Blue Cross Medicare Advantage^SM Members) or Carelon Medical Benefits Management (formerly known as AIM Specialty Health) for some commercial members. These lists are not exhaustive and are not necessarily covered under the member benefits contract. Lists are updated quarterly to comply with AMA and CMS guidelines.

Consult Availity^® or your preferred vendor for eligibility and benefits.

Fully Insured, ASO and HMO Plans

Digital Lookup Tool (For Fully Insured Only)

Review categories below to find out if a member's procedure may require prior authorization.

• Medical Procedure
• Medical Drugs
• Behavioral Service

Procedure Code Lists

• 2024 Prior Authorization Requirements - Summary of Services
• 2024 Commercial Behavorial Health Prior Authorization Codes
• 2024 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes
• 2024 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes
• 2024 Commercial Outpatient Specialty Pharmacy Prior Authorization Codes

• Summary/Code List Archive

For Blue Cross Medicare Advantage Prior Authorization Requirement and Procedure Code List visit the Blue Cross Medicare Advantage page.

Predetermination, Post-Service Review and Non-Covered Code List

• 2024 Recommended Clinical Review (Predetermination), Post-Service Review and Non-Covered Procedure Code
• 2023 Commercial Procedure Code List - Fully Insured - Recommended Clinical Review (Predetermination), Medical Necessity and Non-Covered Services
• 2022 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services
• 2021 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services

The attached lists are for reference only and are not intended to be a substitute for benefit verification or BCBSOK's medical policies. All lists above apply only to members who have health insurance through a Blue Cross and Blue Shield of Oklahoma Plan or who are covered by a group plan administered by BCBSOK. If your patient is covered under a different Blue Cross and Blue Shield Plan, please refer to the Medical Policies of that Plan.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSOK.

Carelon Medical Benefits Management is an independent specialty medical benefits management company that provides utilization management services for 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. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.