TurningPoint updated its medical policies for musculoskeletal procedures and related services

TurningPoint Healthcare Solutions LLC updated various medical policies for musculoskeletal procedures and related services based on feedback from the provider community. The updated policies went into effect on July 26, 2021.

To view the updated policies, access the TurningPoint Provider Portal** and click on Help in the menu at the top of the screen.

Criteria used to make determinations on authorization requests
As a reminder, TurningPoint uses the following criteria to make determinations on authorization requests for musculoskeletal and pain management procedures.

• For Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members: TurningPoint applies medical policy guidelines for musculoskeletal and pain management procedures that Blue Cross, BCN and TurningPoint agreed on.
• For Medicare Plus Blue℠ and BCN Advantage℠ members: TurningPoint applies the Medicare national coverage determinations and Medicare local coverage determinations.

If there is no Medicare NCD and LCD, TurningPoint applies medical policy guidelines for musculoskeletal and pain management procedures that Blue Cross, BCN and TurningPoint agreed on.

Additional information
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

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

***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.