MedicaidPrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS Texas·TX · Oncology·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jun 2, 2026
Summary
Blue Cross Blue Shield of Texas is implementing new prior authorization requirements for government program members. Drug therapy codes for Medicaid members will require prior authorization starting August 1, 2026, and select Proton Beam codes for Medicare Advantage members will require prior authorization starting October 1, 2026.
Action Required
By August 1, 2026: Billing team must update systems to require prior authorization for drug therapy codes for Medicaid members through BCBSTX. By October 1, 2026: Update systems to require prior authorization for select Proton Beam codes for Medicare Advantage members through BCBSTX and EviCore healthcare. Always verify eligibility and benefits through Availity Essentials before rendering services. Services performed without required prior authorization may be denied for payment.