New cardiology authorizations program to launch Aug. 20, 2024 for dates of service on and after Sept. 1, 2024
Updates:
- May 29, 2024: Updated go-live date to Sept. 1, 2024
- Aug. 6, 2024: Added impacted procedure codes table in place of service categories list. Added information about trial phase starting August 20. Added links to provider training information.
In addition to MSK managed care, we're partnering with TurningPoint on a new authorization program for cardiac surgical procedures, designed to facilitate provider-to-provider collaboration on each member’s care plan. This new program will launch for dates of service on and after Sept. 1, 2024. The goal of this partnership is to optimize health outcomes for cardiac patients and work more closely with you, our provider partners, on evidence-based, value-driven care.
Starting August 20, you'll have the opportunity to test the new authorization submissions process. You'll initiate your authorization requests in our provider portal, prism, as you do now. These requests will then be routed to TurningPoint for review. (Learn more below.)
Procedures requested for dates of service on and after September 1 will be reviewed against TurningPoint’s clinical criteria. Providers will be able to find this criteria in TurningPoint’s portal under the Policies section starting on August 20.
About TurningPoint
TurningPoint is an independent specialty condition management company with 120+ clinical experts focused on sub-specialties in high-complexity, high-cost categories – including cardiology. Their process is aligned with our clinical approach by reviewing requested care and using evidence-based guidelines to develop care plans in collaboration with network physicians.
How does TurningPoint work?
You'll initiate the authorization request process in prism, as you do now. prism’s Request an Authorization page will be updated to include redirection to TurningPoint, in addition to GuidingCare and EviCore.
When a cardiac procedure requires authorization through TurningPoint, prism will automatically redirect you to TurningPoint’s online authorization portal.
TurningPoint cardiac physicians will then review each authorization request, initiating a discussion with the requesting physician if needed to shape the member’s care plan. The goal with each request is to get our members the right care at the right time at the right cost and site of care. TurningPoint’s process results in a lower denial rate and a reduction in appeals.
What procedures will require authorization through TurningPoint?
Beginning August 20 for dates of service on and after September 1, the following service categories will require authorization through TurningPoint, for both inpatient and outpatient procedures, including all associated partial, total and revision surgeries:
| Procedure type | CPT codes (bold indicates a new prior authorization requirement) |
| Cardiac Non-Specific | 33202, 33203, 33210, 33211, C1874, C1875, C1876, C1877, C1899, C1900, C2617, C2625 |
| Coronary Angioplasty/Stenting | 92928, 92929, 92933, 92934, 92937, 92938, 92943, 92944, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608, 92920, 92921, 92925 |
| Coronary Artery Bypass Grafting | 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33572, 4110F, S2205, S2206, S2207, S2208, S2209 |
| ICD Revision or Removal | 33241, 33243, 33244, 33262, 33263, 33264, 0573T, 0574T, 0580T |
| Implantable Cardioverter Defibrillator | 33230, 33231, 33240, 33249, 33270, 33271, 0571T, 0572T, C1721, C1722, C1777, C1882, C1895, C1896, G0448 |
| Internal Cardiac Monitoring | 33285, 33286, C1764, E0616 |
| Leadless Pacemaker | 33274, 33275, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, 0803T, 0823T, 0824T, 0825T, 0861T, 0862T, 0863T |
| Non-Coronary Angioplasty/Stenting | 37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249, 0075T, 0076T, C1880 |
| Pacemaker | 33206, 33207, 33208, 33212, 33213, 33214, 33221, 33225, C1779, C1785, C1786, C1898, C2619, C2620, C2621, 0515T, 0516T, 0517T, 0519T, 0520T |
| Pacemaker Revision or Removal | 33227, 33228, 33229, 33233, 33236, 33237 |
| Percutaneous Left Atrial Appendage Occluder | 33340 |
| Peripheral Revascularization | 33224, 35302, 35303, 35304, 35305, 35371, 35372, 35556, 35558, 35566, 35571, 35583, 35585, 35587, 35656, 35661, 35666, 35671, 35700, 35881, 35883, 35884, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, C2623 |
| Valve Replacement | 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33405, 33406, 33410, 33411, 33412, 33413, 33418, 33419, 33430, 33440, 33465, 33475, 33477, 0483T, 0484T, 0646T |
| Wearable Cardiac Defibrillator | 93745, E0617, K0606 |
Provider resources & trainings
We’ve prepared several training resources and opportunities to help you be successful through this transition:
Provider training guide
Download our TurningPoint provider training guide to get an overview of the scope, features and operational process (including step-by-step submission instructions, peer-to-peer information and appeals details) of the cardiac managed care program.
Web landing page
Visit our new TurningPoint resources webpage which includes FAQs, impacted procedure codes, turnaround times, peer-to-peer and appeals information, and more.
To access this landing page:
- Log into your prism account.
- Under the Authorizations menu, click Request an Authorization.
- On the resulting page, click Auth request help page then Get TurningPoint resources.
Training webinars
Join our utilization management team and TurningPoint staff to learn about the authorization programs, as well as how to navigate and successfully request authorizations through TurningPoint.
Registration is now available for the following dates, with each session starting at 12 p.m. ET:
- August 14
- August 21
- August 28
- September 4
Can’t make it during the webinar’s scheduled time? A recording of the session will be sent to all registrants for on-demand viewing.