New MSK prior authorizations program will launch September 2024
In addition to cardiac managed care, we’re also partnering with TurningPoint on a new authorizations program for musculoskeletal (MSK) procedures, both slated to launch in September 2024.
These programs are designed to facilitate provider-to-provider collaboration on each member’s care plan, with the overall goal to optimize health outcomes and work more closely with you, our provider partners, on evidence-based, value-driven care.
What MSK procedures will require authorization through TurningPoint?
Beginning this September, the following orthopedic and spine surgeries and procedures will require authorization through TurningPoint, for inpatient and outpatient procedures, including all associated partial, total and revision surgeries, for all lines of business.
| Procedure type | CPT codes (bold indicates a new prior authorization requirement in an outpatient setting) |
| ACL repair |
27407, 27409, 29888 |
| Acromioplasty and rotator cuff repair |
23130, 23410, 23412, 23415, 23420, 29826, 29827 |
| Ankle fusion | 27870, 29899 |
| Cervical disk replacement |
22856, 22858, 22861, 22864, 0098T |
| Cervical laminectomy and discectomy |
22100, 22110, 63001, 63015, 63020, 63040, 63043, 63045, 63050, 63051, 63075, 63076, 63250, 63265, 63270, 63275, 63280, 63285 |
| Cervical laminectomy, laminoplasty, and discectomy |
0274T |
| Cervical spinal fusion | 22548, 22551, 22552, 22554, 22590, 22595, 22600 |
| Computer assisted navigation | 20985, 61783 |
| Elbow replacement | 24160, 24164, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371 |
| Femoroacetabular arthroscopy |
27299, 29914, 29915, 29916 |
| Hip arthroscopy | 29860, 29861, 29862, 29863 |
| Hip osteotomy | 27146, 27147, 27151, 27156, 27158, 27161 |
| Hip resurfacing | 27033, 27125, 27236 |
| Implantable infusion pumps | 62350, 62351, 62360, 62361, 62362, 62365, E0782 |
| Knee arthroscopy | 27331, 27332, 27333, 27403, 27405, 27427, 27428, 27429, 29850, 29851, 29855, 29856, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29884, 29885, 29886, 29887, 29889, 29999 0707T |
| Knee fusion | 27580 |
| Laminectomy - unspecified | 63170, 63172, 63173, 63185, 63190, 63191 |
| Lumbar decompression |
63052, 63053 |
| Lumbar disc replacement | 22857, 22862, 22865, 0163T, 0164T, 0165T |
| Lumbar laminectomy, discectomy, and laminotomy | 22102, 22114, 62287, 62380, 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047, 63048, 63056, 63057, 63200, 63267, 63272, 63277, 63282, 63290, 63303, 0275T, C9757, S2348, S2350, S2351 |
| Lumbar spinal fusion | 22533, 22558, 22586, 22612, 22630, 22633 |
| Manipulation under anesthesia | 22505, 23700, 24300, 27275, 27570, 27860 |
| Meniscal repair and allograft transplantation | 29868, 29882, 29883 |
| MPFL reconstruction | 27418, 27420, 27422, 27424, 27425 |
| Open shoulder procedures | 23040, 23044, 23100, 23101, 23105, 23106, 23107, 23120, 23125, 23395, 23397, 23405, 23406, 23430, 23440, 23450, 23455, 23460, 23462, 23465, 23466 |
| Osteochondral defect repair | 27412, 27415, 27416, 28446, 29866, 29867 |
| Partial knee replacement | 27437, 27438, 27440, 27441, 27442, 27443, 27446 |
| Pubic symphysis fusion | 27282 |
| Revision of total hip replacement | 27090, 27091, 27134, 27137, 27138 |
| Revision of total knee replacement | 27486, 27487, 27488 |
| Sacral decompression | 63011, 63268, 63273, 63278, 63283 |
| Sacroiliac joint fusion | 27279, 27280 |
| Shoulder arthroscopy | 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29828 |
| Shoulder fusion | 23400, 23800, 23802 |
| Shoulder replacement (total, reverse, revision, hemi) |
23334, 23335, 23470, 23472, 23473, 23474, 23616 |
| Spinal cord neurostimulator | 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, C1816, C1822 |
| Spinal devices | 22867, 22868, 22869, 22870, 0202T, 0219T, 0220T, 0221T, 0222T |
| Spinal fusion - unspecified | 22534, 22585, 22614, 22632, 22634, 22830 |
| Spine non-specific | 20930, 20931, 20936, 20937, 20938, 20939, 22103, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22818, 22819, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22854, 22855, 22859, 22899, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63295, 63300, 63301, 63302, 63304, 63305, 63306, 63307, 63308 |
| Surgery for spinal deformity |
22800, 22802, 22804, 22808, 22810, 22812, 0656T, 0657T |
| Thoracic laminectomy and discectomy | 22101, 22112, 63003, 63016, 63046, 63055, 63064, 63066, 63077, 63078, 63197, 63251, 63252, 63266, 63271, 63276, 63281, 63286, 63287 |
| Thoracic spinal fusion | 22532, 22556, 22610 |
| Total ankle replacement and revision | 27702, 27703, 27704 |
| Total hip replacement | 27130, 27132, 27284, 27286 |
| Total knee replacement | 27445, 27447 |
| Unlisted procedure code | 27599 |
| Vertebral augmentation | 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T, C1062 |
| Wrist fusion |
25800, 25805, 25810, 25820, 25825 |
| Wrist replacement | 25332, 25441, 25442, 25443, 25444, 25445, 25446 |
What’s next?
In the coming weeks, we'll share additional information to ensure your providers have ample opportunity to be trained on using TurningPoint’s online authorization portal and to ask any questions they may have. Additional information will include:
- FAQs
- Peer-to-peer and appeals information
- Training webinars
- Provider instruction manual
- And more