New MSK prior authorizations program will launch August 20 for dates of service on and after September 1
Updates
- Aug. 6, 2024: Added information about trial phase starting August 20. Added links to provider training information.
In addition to cardiac managed care, we’re also partnering with TurningPoint on a new authorizations program for musculoskeletal (MSK) procedures. This new program will launch for dates of service on and after Sept. 1, 2024.
These programs are designed to facilitate provider-to-provider collaboration on each member’s care plan, with the overall goal to optimize health outcomes 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.
What MSK procedures will require authorization through TurningPoint?
Beginning this September, the following orthopedic and spine surgeries and procedures will require authorization through TurningPoint, for inpatient and outpatient procedures, including all associated partial, total and revision surgeries, for all lines of business.
| Procedure type | CPT codes (bold indicates a new prior authorization requirement in an outpatient setting) |
| ACL repair |
27407, 27409, 29888 |
| Acromioplasty and rotator cuff repair |
23130, 23410, 23412, 23415, 23420, 29826, 29827 |
| Ankle fusion | 27870, 29899 |
| Ankle replacement | 27700 |
| Cervical disk replacement |
22856, 22858, 22861, 22864, 0098T |
| Cervical laminectomy and discectomy |
22100, 22110, 63001, 63015, 63020, 63040, 63043, 63045, 63050, 63051, 63075, 63076, 63250, 63265, 63270, 63275, 63280, 63285 |
| Cervical laminectomy, laminoplasty, and discectomy |
0274T |
| Cervical spinal fusion | 22548, 22551, 22552, 22554, 22590, 22595, 22600 |
| Computer assisted navigation | 20985, 61783, 0054T, 0055T |
| Elbow replacement | 24160, 24164, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371 |
| Femoroacetabular arthroscopy |
27299, 29914, 29915, 29916 |
| Hip arthroscopy | 29860, 29861, 29862, 29863 |
| Hip osteotomy | 27146, 27147, 27151, 27156, 27158, 27161 |
| Hip resurfacing | 27033, 27120, 27122, 27125, 27236, S2118 |
| Interspinous process fixation / stabilization device | C1821 |
| Knee arthroscopy | 27331, 27332, 27333, 27403, 27405, 27427, 27428, 27429, 29850, 29851, 29855, 29856, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29884, 29885, 29886, 29887, 29889, 29999, 0707T, G0289 |
| Knee fusion | 27580 |
| Laminectomy - unspecified | 63170, 63172, 63173, 63185, 63190, 63191 |
| Lumbar decompression |
63052, 63053 |
| Lumbar disc replacement | 22857, 22862, 22865, 0164T, 0165T |
| Lumbar laminectomy, discectomy, and laminotomy | 22102, 22114, 62287, 62380, 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047, 63048, 63056, 63057, 63200, 63267, 63272, 63277, 63282, 63290, 63303, 0275T, C9757, S2348, S2350, S2351 |
| Lumbar spinal fusion | 22533, 22558, 22586, 22612, 22630, 22633 |
| Manipulation under anesthesia | 22505, 23700, 24300, 27275, 27570, 27860 |
| Meniscal repair and allograft transplantation | 29868, 29882, 29883, G0428 |
| MPFL reconstruction | 27418, 27420, 27422, 27424, 27425 |
| Neuro stimulator | 0784T, 0785T, C1767, C1778, C1787, C1820, C1897, L8679, L8680, L8681, L8682, L8683, L8685, L8686, L8687, L8688, L8689, L8695 |
| Open shoulder procedures | 23040, 23044, 23100, 23101, 23105, 23106, 23107, 23120, 23125, 23395, 23397, 23405, 23406, 23430, 23440, 23450, 23455, 23460, 23462, 23465, 23466 |
| Osteochondral defect repair | 27412, 27415, 27416, 28446, 29866, 29867, 29892, J7330, S2112 |
| Partial knee replacement | 27437, 27438, 27440, 27441, 27442, 27443, 27446 |
| Revision of total hip replacement | 27090, 27091, 27134, 27137, 27138 |
| Revision of total knee replacement | 27486, 27487, 27488 |
| Sacral decompression | 63011, 63268, 63273, 63278, 63283 |
| Sacroiliac joint fusion | 27278, 27279, 27280 |
| Shoulder arthroscopy | 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29828 |
| Shoulder arthrotomy | 23190, 23195, 23333 |
| Shoulder fusion | 23400, 23800, 23802 |
| Shoulder replacement (total, reverse, revision, hemi) |
23334, 23335, 23470, 23472, 23473, 23474, 23616 |
| Spinal cord neurostimulator | 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, C1816, C1822 |
| Spinal devices | 22867, 22868, 22869, 22870, 0202T, 0219T, 0220T, 0221T, 0222T |
| Spinal fusion - unspecified | 22534, 22585, 22614, 22632, 22634, 22830 |
| Spine non-specific | 20930, 20931, 20936, 20937, 20938, 20939, 22103, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22818, 22819, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22854, 22855, 22859, 22899, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63295, 63300, 63301, 63302, 63304, 63305, 63306, 63307, 63308 |
| Surgery for spinal deformity |
22800, 22802, 22804, 22808, 22810, 22812, 22836, 22837, 22838, 0656T, 0657T, 0790T |
| Thermal intradiscal procedures | 22526, 22527 |
| Thoracic laminectomy and discectomy | 22101, 22112, 63003, 63016, 63046, 63055, 63064, 63066, 63077, 63078, 63197, 63251, 63252, 63266, 63271, 63276, 63281, 63286, 63287 |
| Thoracic spinal fusion | 22532, 22556, 22610 |
| Total ankle replacement and revision | 27702, 27703, 27704 |
| Total hip replacement | 27130, 27132, 27284, 27286 |
| Total knee replacement | 27445, 27447 |
| Unlisted procedure code | 27599 |
| Vertebral augmentation | 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T, C1062 |
| Wrist fusion |
25800, 25805, 25810, 25820, 25825 |
| Wrist replacement | 25332, 25441, 25442, 25443, 25444, 25445, 25446, 25449 |
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 MSK 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.