TurningPoint to review sites of care for total hip and knee surgeries for some members

For dates of service on or after Jan. 3, 2022, TurningPoint Healthcare Solutions LLC will review the site of care for total hip and knee surgeries as part of each authorization determination. Based on medical necessity review, TurningPoint may approve authorization requests for select total hip and knee cases only when scheduled in an outpatient setting.

This applies to members with the following coverage:

• Medicare Plus Blue℠
• BCN commercial
• BCN Advantage℠

If TurningPoint approves an authorization for a hip or knee surgery in an outpatient setting and the member experiences a change in condition that requires an inpatient admission, you’ll need to submit an authorization request for the inpatient admission (procedure code *99222) through the e‑referral system; see the “Submit an inpatient authorization” section of the e-referral User Guide for more information. Blue Cross Blue Shield of Michigan or Blue Care Network will review the request, using InterQual^® criteria.

Performing total hip and knee surgeries in outpatient settings is supported by both evidence-based guidelines and the Centers for Medicare & Medicaid Services.

For more information about the TurningPoint musculoskeletal surgical quality and safety management program, see these pages on the ereferrals.bcbsm.com website:

• BCN Musculoskeletal Services
• Blue Cross Musculoskeletal Services