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
- Lumbar Disc Replacement
- Lumbar Laminectomy, Discectomy, and Laminotomy
- Lumbar Spinal Fusion
- Sacral Decompression
- Sacroiliac Joint Fusion
- Spinal Cord Stimulator
- Spinal Devices
- Spinal Osteotomy
- Surgery for Spinal Deformity
- Thoracic Laminectomy and Discectomy
- Thoracic Spinal Fusion
- Vertebral Augmentation (Kyphoplasty and Vertebroplasty
- Vertebral Corpectomy
Adjunct Spine- Instrumentation, Grafts, Etc.
20931
20936
20937
20938
20939
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22852
22853
22854
22855
22859
22899
61783
63295
Cervical Disc Replacement
22858
22861
22864
0098T
Cervical Laminectomy and Discectomy
22103
22110
22116
63001
63015
63020
63035
63040
63043
63045
63048
63050
63051
63075
63076
63170
63172
63173
63185
63190
63191
63250
63265
63270
63275
63280
63285
Cervical Spinal Fusion
22548
22551
22552
22554
22585
22590
22595
22600
22614
Implantable Infusion Pump
62367
62368
62369
62370
C1772
C1891
C2626
E0782
E0783
E0785
E0786
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
0165T
22857
22860
22862
22865
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
0275T
22102
22114
62380
63005
63012
63017
63030
63042
63044
63047
63052
63053
63056
63057
63200
63252
63267
63272
63277
63282
63290
C9757
S2350
S2351
Lumbar Spinal Fusion
22328
22533
22534
22558
22586
22612
22630
22632
22633
22634
Sacral Decompression
63268
63273
63278
63283
Sacroiliac Joint Fusion
27279
27280
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 0775T.
Spinal Cord Stimulator
63662
63688
C1767
C1778
C1787
C1816
C1820
C1822
C1897
L8679
L8680
L8681
L8682
L8683
L8685
L8686
L8687
L8688
L8689
L8695
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
0220T
0221T
0222T
22867
22868
22869
22870
Spinal Osteotomy
22207
22208
22210
22212
22214
22216
22220
22222
22224
22226
Surgery for Spinal Deformity
0657T
22800
22802
22804
22808
22810
22812
Thoracic Laminectomy and Discectomy
22112
63003
63016
63046
63055
63064
63066
63077
63078
63197
63251
63266
63271
63276
63281
63286
63287
Thoracic Spinal Fusion
22532
22556
22610
Vertebral Augmentation (Kyphoplasty and Vertebroplasty
0201T
0202T
22510
22511
22512
22513
22514
22515
C1062
C7504
C7505
C7507
C7508
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
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63300
63301
63302
63303
63304
63305
63306
63307
63308
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.