Musculoskeletal services

This page provides information about:

For information about musculoskeletal services for BCN HMOSM and BCN AdvantageSM members, see the BCN Musculoskeletal Services page.

For information about musculoskeletal services for Blue Cross’ PPO and Medicare Plus BlueSM PPO members, see the Blue Cross Musculoskeletal Services page.

Joint procedures

Joint procedures

Providers must obtain authorizations for joint replacement surgeries and other related arthroscopic procedures as follows, based on the member's plan or group and the date of service:

Plan or group Date of service Details
Medicare Plus BlueSM PPO Prior to July 1, 2020 Submit authorization requests to Medicare Plus Blue Utilization Management through the e-referral system.

For more information, see the "For Medicare Plus Blue PPO members" section of the Blue Cross Authorization Requirements & Criteria page.
On or after July 1, 2020 Submit authorization requests to TurningPoint Healthcare Solutions LLC.
  • All Blue Cross' PPO fully insured groups
  • Select Blue Cross' PPO administrative service contract groups
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
  • BCN HMOSM
  • BCN AdvantageSM
Prior to July 1, 2020 Submit authorization requests to Blue Care Network Utilization Management through the e-referral system.

For more information, see the BCN Authorization Requirements & Criteria page.
On or after July 1, 2020 Submit authorization requests to TurningPoint Healthcare Solutions LLC.

See also: Resources, forms and training for TurningPoint.

Pain management procedures

Pain management procedures

Providers must obtain authorizations for pain management procedures as follows, based on the member’s plan or group and the date of service:

Plan or group Date of service Details
  • All Blue Cross' PPO fully insured groups
  • Select Blue Cross' PPO administrative service contract groups
  • Medicare Plus Blue
Prior to Jan. 1, 2021 Submit authorization requests to eviCore healthcare®.

For more information, see the Blue Cross eviCore-Managed Procedures page.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
  • BCN HMO
  • BCN Advantage
Prior to Jan. 1, 2021 Submit authorization requests to eviCore healthcare®.

For more information, see the BCN eviCore-Managed Procedures page.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.

See also: Resources, forms and training for TurningPoint

Spine procedures

Spine procedures

Providers must obtain authorizations for spinal surgeries as follows, based on the type of surgery or procedure, the member’s plan or group and the date of service:

Providers must obtain authorizations for spinal surgeries as follows, based on the member’s plan or group and the date of service:

Surgery or procedure Plan or group Date of service Details
Cervical spine
  • Blue Cross' PPO fully insured groups
  • Select Blue Cross' PPO ASC groups
  • Medicare Plus Blue
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
Lumbar spine
  • Blue Cross' PPO fully insured groups
  • Medicare Plus Blue
Prior to Jan. 1, 2021 Submit authorization requests to eviCore healthcare.

For more information, see the Blue Cross eviCore-Managed Procedures page.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
Select Blue Cross' PPO ASC groups Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
  • Catheter implantations on spine and spinal cord
  • Reservoir pump/pump implantation procedure on spine and spinal cord
  • Neurostimulator (spine) procedures
  • Blue Cross' PPO fully insured groups
  • Select Blue Cross' PPO ASC groups
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
Medicare Plus Blue Prior to Jan. 1, 2021 Submit authorization requests to Medicare Plus Blue Utilization Management.
On or after Jan. 1, 2021 Starting Dec. 1, 2020, submit authorization requests to TurningPoint.
Plan or group Date of service Details
  • BCN HMO
  • BCN Advantage
Prior to July 1, 2020 Submit authorization requests to BCN Utilization Management through the e-referral system.

For more information, see the BCN Authorization Requirements & Criteria page.
On or after July 1, 2020 Submit authorization requests to TurningPoint.

See also: Resources, forms and training for TurningPoint

Resources, forms and training for TurningPoint

Resources, forms and training for TurningPoint

Refer to the following resources for more information:

TurningPoint forms

Turning Point provider training – Spine and joint, for the July 1, 2020 program implementation

  • Professional provider training — Includes information about TurningPoint's clinical model and operational changes, along with information about working in the TurningPoint Provider Portal
  • Facility training — Includes information about TurningPoint's clinical model and operational changes, along with information about the facility verification process
  • Portal training — Includes information about working in the TurningPoint Provider Portal

See the BCN Musculoskeletal Services page for information specific to BCN HMO and BCN Advantage members.

See the Blue Cross Musculoskeletal Services page for information specific to Blue Cross' PPO and Medicare Plug Blue members.

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