Musculoskeletal services

TurningPoint Healthcare Solutions LLC manages authorizations for musculoskeletal procedures for most Blue Cross and BCN members.

This page provides information about:

For information about musculoskeletal services for BCN commercial and BCN AdvantageSM members, see the BCN 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
Medicare Plus BlueSM On or after July 1, 2020 Submit authorization requests to TurningPoint Healthcare Solutions LLC.

Blue Cross commercial*

  • All fully insured groups
  • Select self-funded groups
  • All members with individual coverage
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021, unless otherwise noted Submit authorization requests to TurningPoint.

Note: Self-funded groups were eligible to join this program for dates of service on or after Jan. 1, 2021. This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021; providers can submit authorization requests to TurningPoint for URMBT members starting on May 3, 2021.

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
  • Blue Cross commercial*
    • All fully insured groups
    • Select self-funded groups
    • All members with individual coverage
  • 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, unless otherwise noted Submit authorization requests to TurningPoint.

Note: Self-funded groups were eligible to join this program for dates of service on or after Jan. 1, 2021. This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021; providers can submit authorization requests to TurningPoint for URMBT members starting on May 3, 2021.

See also: Resources, forms and training for TurningPoint

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:

Surgery or procedure Plan or group Date of service Details
Cervical spine
  • Blue Cross commercial*
    • All fully insured groups
    • Select self-funded groups
    • All members with individual coverage
  • Medicare Plus Blue
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021, unless otherwise noted Submit authorization requests to TurningPoint.

Note: Self-funded groups were eligible to join this program for dates of service on or after Jan. 1, 2021. This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021; providers can submit authorization requests to TurningPoint for URMBT members starting on May 3, 2021.
Lumbar spine
  • Blue Cross commercial*
    • All fully insured groups
    • All members with individual coverage
  • 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 commercial self-funded groups* Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Submit authorization requests to TurningPoint.

Note: Self-funded groups were eligible to join this program for dates of service on or after Jan. 1, 2021. This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021; providers can submit authorization requests to TurningPoint for URMBT members starting on May 3, 2021.
  • Catheter implantations on spine and spinal cord
  • Reservoir pump/pump implantation procedure on spine and spinal cord
  • Neurostimulator (spine) procedures

Blue Cross commercial*

  • All fully insured groups
  • Select self-funded groups
  • All members with individual coverage
Prior to Jan. 1, 2021 Authorization isn't required.
On or after Jan. 1, 2021 Submit authorization requests to TurningPoint.

Note: Self-funded groups were eligible to join this program for dates of service on or after Jan. 1, 2021. This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021; providers can submit authorization requests to TurningPoint for URMBT members starting on May 3, 2021.
Medicare Plus Blue Prior to Jan. 1, 2021 Submit authorization requests to Medicare Plus Blue Utilization Management.
On or after Jan. 1, 2021 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:

TurningPoint forms

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
  • 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 commercial and BCN Advantage members.

*To determine whether you need to submit prior authorization requests for members who have coverage through self-funded groups, complete the steps in "How do I know if I need to request prior authorization from TurningPoint for members who have coverage through Blue Cross commercial plans?" in the Musculoskeletal procedure authorizations: Frequently asked questions for providers document.

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