We’ve made updates to list of musculoskeletal procedure codes that require prior authorization

We recently updated the Musculoskeletal procedure codes that require authorization by TurningPoint document to reflect the following changes:

• For dates of service on or after March 19, 2023, procedure code *64625 is no longer payable for Medicare Plus Blue℠ or BCN Advantage℠ members.
  Note: This procedure code continues to be payable for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. It requires prior authorization for BCN commercial members. It doesn’t require prior authorization for Blue Cross commercial members.
• For dates of service on or after March 25, 2023, procedure code C1767 doesn’t require prior authorization for Medicare Plus Blue, BCN commercial or BCN Advantage members.
  Note: This procedure code has never required prior authorization for Blue Cross commercial members.
• For dates of service on or after July 1, 2023, procedure code *0775T will require authorization for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members.

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

• Blue Cross Musculoskeletal Services
• BCN Musculoskeletal Services

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.

TurningPoint Healthcare Solutions LLC is an independent company that manages prior authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network.