Additional enhancements to TurningPoint musculoskeletal surgical quality and safety management program

In the June 2021 issue of The Record, we announced several enhancements to the TurningPoint Healthcare Solutions LLC musculoskeletal surgical quality and safety management program.

Since then, Blue Cross Blue Shield of Michigan, Blue Care Network and TurningPoint have identified several opportunities to enhance the pain management portion of the program. Changes include:

• Updating medical policies for several pain management procedures
• Updating questionnaires for pain management procedures
• Removing prior authorization requirements for select procedures

Changes to TurningPoint medical policies for some pain management procedures

As of May 25, 2021, TurningPoint updated pain management medical policies to align more closely with Centers for Medicare & Medicaid Services guidelines. Pain management medical policies have been updated as follows.

Frequency of sessions allowed for epidural steroid injections

Number of levels allowed per session for epidural steroid injections

Time frame requirements for conservative treatments

Note: TurningPoint applies CMS local and national coverage determination guidelines for Medicare Plus Blue℠ and BCN Advantage℠ members. For more information about the criteria TurningPoint uses to make determinations on authorization requests for pain management procedures for all members, see this news item on the ereferrals.bcbsm.com website.

Pain management questionnaire updates

As of May 31, 2021, we stopped requiring answers to the following questions on the questionnaires within the TurningPoint Provider Portal and pain management fax forms:

• What is the patient’s current health status?
• Activities of daily living (ADL) functional status
• For a BMI over 30, which weight loss activities have been documented?

Soon, we’ll remove these questions from the questionnaires.

Removing prior authorization requirements for select procedures

For dates of service on or after July 1, 2021, we won’t require prior authorization for the following procedure codes for refilling and recharging pain pumps: *62367, *62368, *62369 and *62370.

Additional information

As a reminder, TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following groups and members:

• 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.