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Medical Necessity Review of Observation Services

March 19, 2021

As a reminder, it is the policy of BCBSTX to provide coverage for observation services when it is determined to be medically necessary based on the medical criteria and guidelines as outlined in the MCG Care Guidelines Learn more about third-party links. Claims for observation services are subject to post- service review, and BCBSTX may request medical records for the determination of medical necessity.