TurningPoint Healthcare Solutions
Sunshine Health has contracted with TurningPoint Healthcare Solutions, LLC for Musculoskeletal Surgical Procedures, effective May 13, 2019, for Ambetter (Marketplace) and Allwell (Medicare) and August 15, 2019, for Medicaid and Healthy Kids.
The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Sunshine Health members.
Sunshine Health oversees the new Musculoskeletal Surgical Quality and Safety Management Program and is responsible for claims adjudication. Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to TurningPoint Healthcare Solutions, LLC. and will be required for the following surgical procedures (and codes listed below) in both inpatient and outpatient settings.
Musculoskeletal
Orthopedic Surgical Procedures
Including all associated partial, total, and revision surgeries
- Knee Arthroplasty
- Unicompartmental/Bicompartmental Knee Replacement
- Hip Arthroplasty
- Shoulder Arthroplasty
- Elbow Arthroplasty
- Ankle Arthroplasty
- Wrist Arthroplasty
- Acromioplasty and Rotator Cuff Repair
- Anterior Cruciate Ligament Repair
- Knee Arthroscopy
- Hip Resurfacing
- Meniscal Repair
- Hip Arthroscopy
- Femoroacetabular Arthroscopy
- Ankle Fusion
- Shoulder Fusion
- Wrist Fusion
- Osteochondral Defect Repair
Spinal Surgical Procedures
Including all associated partial, total, and revision surgeries
- Spinal Fusion Surgeries
- Cervical
- Lumbar
- Thoracic
- Sacral
- Scoliosis
- Disc Replacement
- Laminectomy/Discectomy
- Kyphoplasty/Vertebroplasty
- Sacroiliac Joint Fusion
- Implantable Pain Pumps
- Spinal Cord Neurostimulator
- Spinal Decompression
NOTE: The Coding sets identified below are subject to quarterly additions/deletions per CMS guidelines. To account for these changes, or any inadvertent omissions directly related to the procedures on the TurningPoint Clinical Scope of Services, codes may be added or deleted throughout the term of the program.
CPT Coding
20930
20931
20936
20937
20938
22100
22101
22102
22103
22110
22112
22114
22116
22206
22207
22208
22210
22212
22214
22216
22220
22222
22224
22226
22325
22326
22327
22328
22510
22511
22512
22513
22514
22515
22532
22533
22534
22548
22551
22552
22554
22556
22558
22585
22586
22590
22595
22600
22610
22612
22614
22630
22632
22633
22634
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22852
22853
22854
22855
22856
22857
22859
22861
22862
22864
22865
22899
23130
23333
23334
23335
23410
23412
23415
23420
23470
23472
23473
23474
23616
23800
23802
24160
24164
24360
24361
24362
24363
24365
24366
24370
24371
25332
25441
25442
25443
25444
25445
25446
25800
25805
25810
25820
25825
27033
27090
27091
27120
27122
27125
27130
27132
27134
27137
27138
27280
27299
27360
27405
27407
27409
27412
27415
27416
27437
27438
27440
27441
27442
27443
27445
27446
27447
27486
27487
27488
27700
27702
27703
27704
27870
29826
29827
29860
29861
29862
29863
29866
29867
29868
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29899
29914
29915
29916
29999
36260
36563
36583
61215
62287
62350
62351
62360
62361
62362
62365
62367
62368
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63050
63051
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252
63265
63267
63268
63270
63271
63272
63275
63277
63280
63282
63285
63286
63287
63290
63300
63301
63302
63303
63304
63305
63306
63307
63308
63650
63655
63661
63662
63663
63664
63685
63688
0163T
0164T
0165T
0195T
0196T
0200T
0201T
0202T
0219T
0220T
0221T
0222T
0274T
0275T
HCPCS Coding
S2118
C1772
C1891
C2626
E0783
E0785
E0786
G0289
S2348
S2350
S2351
C1767
C1778
C1787
C1820
C1883
C1897
L8679
L8680
L8681
L8682
L8683
L8685
L8686
L8687
L8688
L8689
L8695
J7330
S2112