Surgical and Implantable Device Management Program Updates: September 2022
Effective September 19, 2022, additional services will require Prior Authorization & Medical Necessity Determination (PA/MND) review as part of our Surgical and Implantable Device Management Program, managed by TurningPoint Healthcare Solutions, LLC (TurningPoint).
Cardiac Services Updates
Beginning with services provided on and after September 19, 2022 to members participating in this program, TurningPoint will also conduct PA/MND review for the services represented by the CPT® code noted below.
| Code | Description |
|---|---|
| 33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (includes revision of pocket, removal, insertion and/or replacement of existing generator). |
Orthopedic Services Updates
Beginning with services provided on and after September 19, 2022 to members participating in this program, TurningPoint will also conduct PA/MND review for the services represented by the add-on procedure codes noted below.
| Code | Description |
|---|---|
| 20985 | Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (list separately in addition to code for primary procedure) |
| 0054T | Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (list separately in addition to code for primary procedure) |
| 0055T | Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on CT/MRI images (list separately in addition to code for primary procedure) |
| S2900 | Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) |
Review more information, including the full listing of procedure codes subject to PA/MND, information about the PA/MND review process as well as how to access the medical policy guidelines TurningPoint uses to conduct their reviews.
If you have questions, call TurningPoint at 1-833-436-4083 weekdays between 8 a.m. and 5 p.m., Eastern Time.
CPT® is a registered trademark of the American Medical Association.
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 Blue Shield Association.