We’re working with TurningPoint Healthcare Solutions LLC (TurningPoint) and EviCore Healthcare (EviCore) to launch new authorizations programs in the coming weeks.
Below you can find the procedure types and codes that will be managed through these programs. Click a dark green bar to access the applicable information.
Note: The following surgeries and procedures will require authorization through TurningPoint, including those performed in an inpatient or outpatient setting, and including all associated partial, total and revision surgeries, for all plans.
| 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 |
Note: The following orthopedic and spine surgeries and procedures will require authorization through TurningPoint, including those performed in an inpatient or outpatient setting, and including all associated partial, total and revision surgeries, for all plans.
| 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 | 0785T, 0784T, 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 |
Effective Sept. 15, 2024, for dates of service on and after Sept. 15, 2024, the following procedures will require authorization through EviCore when performed in an outpatient setting.
Note: The following services will require authorization through EviCore when done in an outpatient setting, for all plans.
| Procedure type | Codes requiring auth (new auth requirements in bold) |
| Brachytherapy
| 0394T, 0395T, 77761, 77762, 77763, 77767, 77768, 77770, 77772, 77778
|
| Stereotactic radiation therapy
| 77371, 77372, 77373, G0339, G0340 |
| Intensity modulated radiation therapy (IMRT)
| 77385, 77386, G6015, G6016 |
| Neutron beam radiation therapy
| 77423 |
| Intraoperative radiation therapy (IORT) | 77424, 77425 |
| Proton beam radiation therapy | 77520, 77522, 77523, 77255 |
| Hyperthermia treatment | 77600, 77605, 77610, 77615, 77620 |
| Radiation treatment delivery | 77401, 77402, 77407, 77412, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010,
G6011, G6012, G6013, G6014 |
| Image-guided radiation (IGRT)
| 77014, 77387, G6001 ,G6002, G6017 |
| Therapeutic radiopharmaceuticals
| 77750, 79005, C2616, S2095 |
For more information about these programs, including access to provider training materials: