Spine Procedure Codes

TurningPoint Healthcare Solutions, LLC (TurningPoint) will perform Prior Authorization or Medical Necessity Determination review of the spine services represented by the CPT® and HCPCS codes listed here as part of our Surgical and Implantable Device Management Program.

Please note that the spine procedure codes listed below apply to the Surgical and Implantable Device Management Programs offered for both Horizon BCBSNJ and Horizon NJ Health patients.

This content was last revised on January 30, 2023 and may be subject to change.

Adjunct Spine- Instrumentation, Grafts, Etc.

Cervical Disc Replacement

Cervical Laminectomy and Discectomy

Cervical Spinal Fusion

Implantable Infusion Pump

Submit PA/MND requests to Horizon for SHBP/SEHBP patients

• TurningPoint does not conduct PA/MND reviews of spine-related services to be provided to members enrolled in State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) plans as they do not participate yet in our Surgical and Implantable Device Management Program for Spine Services.

  Please submit PA/MND requests to Horizon via our online Utilization Management Request Tool for codes 62350, 62351, 62360, 62361 or 62362 for services provided to patients enrolled in State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) plans.

Lumbar Disc Replacement

Recent/Upcoming Changes

• For services to be provided on and after January 18, 2023, TurningPoint will also perform MND of the services represented by procedure code 22860.

Lumbar Laminectomy, Discectomy, and Laminotomy

Lumbar Spinal Fusion

Sacral Decompression

Sacroiliac Joint Fusion

Recent/Upcoming Changes

• TurningPoint will also perform MND of the services represented by procedure code 0775T.

Spinal Cord Stimulator

Submit PA/MND requests to Horizon for SHBP/SEHBP patients

• TurningPoint does not conduct PA/MND reviews of spine-related services to be provided to members enrolled in State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) plans as they do not participate yet in our Surgical and Implantable Device Management Program for Spine Services.

  Please submit PA/MND requests to Horizon via our online Utilization Management Request Tool for codes 63650, 63655, 63663, 63664 or 63685 for services provided to patients enrolled in State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) plans.

Spinal Devices

Spinal Osteotomy

Surgery for Spinal Deformity

Thoracic Laminectomy and Discectomy

Thoracic Spinal Fusion

Vertebral Augmentation (Kyphoplasty and Vertebroplasty

Recent/Upcoming Changes

• For services to be provided on and after March 1, 2023, TurningPoint will also perform MND of the services represented by procedure codes C7504, C7505, C7507 and C7508.

Vertebral Corpectomy

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

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