Surgical and Implantable Device Management Program Update: Implantable Loop Recorders
Effective January 1, 2021, additional services will require Prior Authorization & Medical Necessity Determination (PA/MND) reviews as part of our Surgical and Implantable Device Management Program for cardiac services.
Beginning with services to be provided on and after January 1, 2021, TurningPoint Healthcare Solutions, LLC (TurningPoint), who administers this program, will conduct PA/MND reviews for the procedure codes related to implantable loop recorders listed below.
|33285||Insertion, subcutaneous cardiac rhythm monitor, including programming|
|33286||Removal, subcutaneous cardiac rhythm monitor|
|C1764||Event recorder, cardiac (implantable)|
|E0616||Implantable cardiac event recorder with memory, activator and programmer|
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 at HorizonBlue.com/turningpoint. You can also review information about the PA/MND review process and the medical policy guidelines TurningPoint uses to conduct their reviews
Medical Policy Criteria and Guidelines
TurningPoint manages and maintains the medical policy criteria and guidelines used to conduct PA/MND reviews as part of this program. We encourage you to review TurningPoint’s Internal Cardiac Monitoring policy.
- You may review TurningPoint’s medical policy criteria and guidelines online. To access this information, sign in to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu, and:
- Mouse over Referrals & Authorization and select TurningPoint PA/MND Requests
- Select Help from the menu bar of TurningPoint’s home page
- Select Medical Policies and Clinical Guidelines within the Helpful Articles section
- If you do not have access to NaviNet, you may access the medical policy criteria and guidelines used to conduct PA/MND reviews as part of this program through TurningPoint’s web portal at myturningpoint-healthcare.com. To register for access to TurningPoint’s web portal, call TurningPoint at 1-833-436-4083, weekdays, between 8 a.m. and 5 p.m., Eastern Time (ET) to register to obtain access credentials.
- You can also obtain copies of medical policy criteria and guidelines by calling TurningPoint at 1-833-436-4083, weekdays between 8 a.m. and 5 p.m., ET.
Please note that TurningPoint’s medical policy criteria and guidelines apply only to those Horizon BCBSNJ members included within the scope of this program.
You may review the Horizon BCBSNJ Medical Policy that applies to members not included in the scope of this program by visiting our Medical Policy Manual and accessing Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry.
If you have questions, call TurningPoint at 1-833-436-4083, weekdays, between 8 a.m. and 5 p.m., ET.