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Spine Procedure Codes Subject to PA/MND

For services to be provided February 1, 2022 and after, 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.

Select a spine category below to review the CPT® and HCPCS codes included as part of this program.

The expansion of the TurningPoint program to include management of spine-related services is subject to the approval of the NJ Department of Banking and Insurance. Horizon hopes to obtain approval prior to the planned February 1, 2022, program effective date. In the event regulatory approval is not obtained by then, the TurningPoint expansion and the sun setting of eviCore’s management of spine-related services will be delayed.

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 the use of an implantable device for coverage. TurningPoint Healthcare Solutions, LLC and eviCore HealthCare are independent from, and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.

Adjunct Spine- Instrumentation, Grafts, Etc.

20930
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

22856
22858
22861
22864
0098T

Cervical Laminectomy and Discectomy

22100
22103
22110
22116
63001
63015
63020
63035
63040
63043
63045
63048
63050
63051
63075
63076
63170
63172
63173
63185
63190
63191
63194
63196
63198
63250
63265
63270
63275
63280
63285

Cervical Spinal Fusion

22326
22548
22551
22552
22554
22585
22590
22595
22600
22614

Implantable Infusion Pump

0163T
0164T
0165T
62350
62351
62360
62361
62362
62365
62367
62368
62369
62370
22857
22862
22865
C1772
C1891
C2626
E0782
E0783
E0785
E0786

Lumbar Disc Replacement

0163T
0164T
0165T
22857
22862
22865

Lumbar Laminectomy, Discectomy, and Laminotomy

0274T
0275T
22102
22114
62380
63005
63012
63017
63030
63042
63044
63047
63056
63057
63200
63252
63267
63272
63277
63282
63290
C9757
S2350
S2351

Lumbar Spinal Fusion

22325
22328
22533
22534
22558
22586
22612
22630
22632
22633
22634

Sacral Decompression

63011
63268
63273
63278
63283

Sacroiliac Joint Fusion

27279
27280

Spinal Cord Stimulator

63650
63655
63661
63662
63663
63664
63685
63688
C1767
C1778
C1787
C1816
C1820
C1822
C1883
C1897
L8679
L8680
L8681
L8682
L8683
L8685
L8686
L8687
L8688
L8689
L8695

Spinal Devices

0219T
0220T
0221T
0222T
22867
22868
22869
22870

Spinal Fusion for Deformity

22800
22802
22804
22808
22810
22812

Spinal Osteotomy

22206
22207
22208
22210
22212
22214
22216
22220
22222
22224
22226

Thoracic Laminectomy and Discectomy

22101
22112
63003
63016
63046
63055
63064
63066
63077
63078
63195
63197
63199
63251
63266
63271
63276
63281
63286
63287

Thoracic Spinal Fusion

22327
22532
22556
22610

Vertebral Augmentation (Kyphoplasty and Vertebroplasty

0200T
0201T
0202T
22510
22511
22512
22513
22514
22515
C1062

Vertebral Corpectomy

63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63300
63301
63302
63303
63304
63305
63306
63307
63308