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TurningPoint Healthcare Solutions (TP)

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