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January 2020 Update: Surgical and Implantable Device Management Program

In January 2020, Horizon BCBSNJ will implement changes to the services included as part of our Surgical and Implantable Device Management program for orthopedic and cardiac services administered by TurningPoint Healthcare Solutions, LLC (TurningPoint).

Cardiac Services

  • TurningPoint will conduct Prior Authorization/Medical Necessity Determination (PA/MND) review of the services represented by the recently approved CPT® codes below for services to be rendered on and after January 23, 2020.

    0571T
    0572T
    0573T
    0574T
    0580T

  • Effective January 1, 2020, TurningPoint will no longer conduct PA/MND of services with CPT code 36906.

Orthopedic Services

  • Effective January 1, 2020, TurningPoint will no longer conduct PA/MND of services with CPT code 27360.

View more information about this program, including a full listing of the procedures and CPT codes that are subject to PA/MND review under this program. You can also review information about the PA/MND review process and medical policy guidelines TurningPoint uses to conduct their reviews.

Visit our Surgical and Implantable Device Management Program webpage for more information or to review the complete lists of orthopedic services and cardiac services subject to PA/MND review by TurningPoint.

If you have questions, please call TurningPoint at 1-833-436-4083 Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.

CPT® is a registered trademark of the American Medical Association.

NaviNet® is a registered trademark of NaviNet, Inc.

TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain surgical services that require an implantable device for coverage. TurningPoint Healthcare Solutions, LLC is independent from, and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association

Published on: December 23, 2019, 00:14 a.m. ET
Last updated on: December 23, 2019, 14:15 p.m. ET