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- Authorization Requirements & Criteria
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- Spine Care Referral Program
Additional Resources
This page provides information about:
- Joint procedures
- Pain management procedures
- Spine procedures
- Resources, forms and training for TurningPoint
For information about musculoskeletal services for Blue Cross commercial and Medicare Plus BlueSM members, see the Blue Cross Musculoskeletal Services page.
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 |
|---|---|---|
|
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
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 |
|---|---|---|
|
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
Providers must obtain authorizations for spinal surgeries as follows, based on the member’s plan or group and the date of service:
| Plan or group | Date of service | Details |
|---|---|---|
|
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
Refer to the following resources for more information:
- Musculoskeletal procedure codes that require authorization by TurningPoint (PDF)
- Musculoskeletal procedure code substitutions for orthopedic and spinal surgeries (PDF)
- Clinical documentation requirements for musculoskeletal procedures (PDF)
- Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF)
- Musculoskeletal procedure authorizations: Quick reference for providers (PDF)
- TurningPoint Provider Training Manual (PDF)
- Musculoskeletal services: For authorization determinations (PDF) - Includes information about the utilization management program
TurningPoint forms
- Joint and spine procedures authorization request form (PDF)
- Pain management: Epidural steroid injections authorization request form (PDF)
- Pain management: Facet joint injections authorization request form (PDF)
- Pain management: Neuroablation procedures authorization request form (PDF)
- Pain management: Sacroiliac joint injections authorization request form (PDF)
- Postservice change request form (PDF)
To determine which pain management form to submit, see the “Pain management” section of the Musculoskeletal procedure codes that require authorization by TurningPoint document (PDF). This document specifies which procedure codes fall within each pain management category.
TurningPoint provider training – For the July 1, 2020, and the Jan. 1, 2021, 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
- Webinar recording* (includes audio) (46 minutes)
- Presentation (slides only) (PDF)
- Facility training — Includes information about TurningPoint's clinical model and operational changes, along with information about the facility verification process
- Webinar recording* (includes audio) (37 minutes)
- Presentation (slides only) (PDF)
- Portal training — Includes information about working in the TurningPoint Provider Portal
- Webinar recording* (includes audio) (24 minutes)
- Presentation (slides only) (PDF)
See the Blue Cross Musculoskeletal Services page for information specific to Blue Cross commercial and Medicare Plus Blue members.
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.