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Orthopedic Services

Horizon BCBSNJ collaborates with TurningPoint to administer PA/MND review for certain orthopedic services, many of which require the use of an implantable device.

Review the procedures subject to PA/MND as part of our Surgical and Implantable Device Management Program for Orthopedic Services.

Members included in this program for orthopedic services

TurningPoint will conduct PA/MND reviews of services included in the scope of this program to be provided to members enrolled in the following plans/programs:

  • Horizon BCBSNJ fully insured plans/products including those members enrolled in fully insured plans that include BlueCard® benefits for care received outside of our local service area (i.e., all NJ counties, the contiguous counties in DE, NY and PA, as well as Lehigh County, PA).
  • Beginning July, 1, 2019, TurningPoint will also perform PA/MND review of services to be rendered July, 15, 2019 and after to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.

Resources

Surgical and Implantable Device Management Program for Orthopedic Services Q & A
Surgical and Implantable Device Management Program Provider Training Manual
Surgical and Implantable Device Management Program for Orthopedic Services Procedure Code Listing
Orthopedic Services Medical Policy Criteria and Guidelines

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 orthopedic and cardiac services 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.