Criteria used to make determinations on authorization requests for musculoskeletal procedures
TurningPoint Healthcare Solutions LLC uses the following criteria to make determinations on authorization requests for musculoskeletal and pain management procedures:
- For Blue Cross commercial and BCN commercial members: TurningPoint applies medical policy guidelines for musculoskeletal and pain management procedures that Blue Cross Blue Shield of Michigan, Blue Care Network and TurningPoint agreed on.
- For Medicare Plus BlueSM and BCN AdvantageSM members: TurningPoint applies the Medicare national coverage determinations / Medicare local coverage determinations.
If there is no Medicare NCD / LCD, TurningPoint applies medical policy guidelines for musculoskeletal and pain management procedures that Blue Cross, BCN and TurningPoint agreed on.
You can view the medical policies in the TurningPoint Provider Portal.
Additional information
For more information about the TurningPoint musculoskeletal surgical quality and safety management program, see the Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF) document. This and other documents are available from following pages of this website:
As a reminder, TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following:
- Blue Cross commercial* - All fully insured groups, select self-funded groups and all members with individual coverage
- Medicare Plus Blue members
- BCN commercial members
- BCN Advantage members
*To determine whether you need to submit prior authorization requests for Blue Cross commercial members, see the document titled Determining whether Blue Cross commercial members require prior authorization for musculoskeletal surgeries and related procedures (PDF).
Posted: May 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network