The Record

Prior authorization requirements changing for musculoskeletal pain management, spinal procedure codes

For dates of service on or after June 3, 2024, we’re adding prior authorization requirements for several pain management and spinal procedure codes that are managed through TurningPoint Healthcare Solutions LLC’s Musculoskeletal Surgical Quality and Safety Management program.

The tables below outline the changes. In the tables:

Some of the procedure codes represent specific procedures that have been separated out from more general procedures already managed by TurningPoint.

Other procedure codes replaced codes that were retired by the American Medical Association.

Note: This change doesn’t affect MESSA members. For additional information about which members are affected, see the Musculoskeletal Services and Pain Management Services pages on ereferrals.bcbsm.com.

Pain management procedure codes

Procedure code

Change

*64625

Will require prior authorization for Medicare Plus Blue℠ and BCN Advantage℠ members.

Note: This code will continue to require prior authorization through TurningPoint for Blue Care Network commercial members. It doesn’t require prior authorization for Blue Cross Blue Shield of Michigan commercial members.

Spinal procedure codes

Procedure code

Change

*0784T

Will require prior authorization for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members.

*0785T

*0786T

*0787T

*0790T

Will require prior authorization for Medicare Plus Blue, BCN commercial and BCN Advantage members.

*22836

*22837

*22838

*27278

Will require prior authorization for Medicare Plus Blue, BCN commercial and BCN Advantage members.

Note: For dates of service before June 3, 2024, BCN Utilization Management manages prior authorizations for procedure code *27278 for BCN commercial and BCN Advantage members.

Additional information

For more information about TurningPoint’s Musculoskeletal Surgical Quality and Safety Management program, see the following pages on the ereferrals.bcbsm.com website:

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

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2023 American Medical Association. All rights reserved.