Horizon Blue Cross Blue Shield of New Jersey

11/02/2026 | Press release | Distributed by Public on 11/02/2026 08:53

Surgical and Implantable Device Management Program Medical Policy Updates: February 2027

Effective February 1, 2027, TurningPoint Healthcare Solutions, LLC (TurningPoint) will implement updates to the medical policy guidelines that support the Prior Authorization/Medical Necessity Determinations (PA/MND) reviews they perform as part of our Surgical and Implantable Device Management Program.

As shown in the tables below, TurningPoint's updates may have an adverse or positive/neutral impact on claims submitted for services rendered on and after February 1, 2027.

Orthopedic Services Policies

Updates That May Result in Adverse Claims Impact Updates That May Result in Positive/Neutral Claims Impact
  • OR-1031.26 Hip Arthroscopy
  • OR-1049.26 Percutaneous Tenotomy
  • OR-1001.26 Total Hip Replacement & Revision
  • OR-1002.26 Total Knee Replacement & Revision
  • OR-1013.26 ACL Repair
  • OR-1014.26 Treatment of Osteochondral Defects
  • OR-1018.26 Acromioplasty and Rotator Cuff Repair
  • OR-1019.26 Shoulder Fusion
  • OR-1023.26 Shoulder Replacement
  • OR-1027.26 Meniscal Allograft Transplantation
  • OR-1028.26 Partial Knee Replacement
  • OR-1029.26 Knee Arthroscopy
  • OR-1030.26 Ankle Fusion
  • OR-1032.26 Wrist Fusion
  • OR-1033.26 Wrist Replacement
  • OR-1034.26 Implantable Infusion Pumps
  • OR-1035.26 Computer Assisted Navigation
  • OR-1039.26 Thermal Intradiscal Procedures
  • OR-1045.26 Osteotomies for Spinal Deformity
  • OR-1046.26 Bone Graft Substitutes
    (OR-1046.26 Bone Graft Substitutes is revised to include guidelines from OR-1005 Bone Morphogenetic Protein which is to be retired)
  • OR-1047.26 Orthopedic Applications of Stem Cells
  • OR-1050.26 Hip Core Decompression

Spine Services Policies

Updates That May Result in Adverse Claims Impact Updates That May Result in Positive/Neutral Claims Impact
  • OR-1020.26 Surgery for Spinal Deformity
  • OR-1037.26 Spinal Devices
  • OR-1003.26 Lumbar Disc Replacement
  • OR-1004.26 Lumbar Fusion
  • OR-1006.26 Cervical Disc Replacement
  • OR-1007.26 Cervical Decompression
  • OR-1008.26 Lumbar Decompression
  • OR-1009.26 Sacroiliac Joint Fusion
  • OR-1010.26 Thoracic Decompression
  • OR-1011.26 Thoracic Fusion
  • OR-1012.26 Cervical Fusion
  • OR-1015.26 Spinal Cord Neurostimulator
  • OR-1024.26 Vertebral Augmentation
  • OR-1038.26 Sacral Decompression

Cardiac Services Policies

Updates That May Result in Adverse Claims Impact Updates That May Result in Positive/Neutral Claims Impact
  • CA-1003-26 Pacemaker
  • CA-1001-26 Implantable Cardioverter Defibrillator (ICD)
  • CA-1003-26 Pacemaker
  • CA-1005-26 Coronary Artery Bypass Grafting (CABG)
  • CA-1006-26 Coronary Angioplasty and Stenting
  • CA-1007-26 Non-Coronary Angioplasty and Endovascular Stent
  • CA-1008-26 Implantable Cardiac Monitoring

Review Guideline Updates To Be Implemented

We encourage you to access the TurningPoint Provider Portal to review the future-state medical policy guidelines that will be implemented on February 1, 2027.

To review TurningPoint's updated medical policies:

  1. Access or log in to the TurningPoint Provider Portal.
  2. Select Help from the top navigation menu.
  3. Open Medical Policies
  4. Scan for and open policies whose titles indicate a "Future Effective Date."

Within this same section, you can also access a single document that summarizes upcoming changes to each policy.

  • Navigate as noted above and search for "26 TurningPoint Medical Policy Change Summary - FUTURE EFFECTIVE 2/1/2027".

Policy Questions?

For case support or specific policy questions, please email [email protected].

TurningPoint manages, maintains and displays the medical policy criteria and guidelines that support the Prior Authorization/Medical Necessity Determinations (PA/MND) they make as part of our Surgical and Implantable Device Management Program.

TurningPoint reviews their guidelines regularly and makes updates as needed to reflect advancements in medical technology and evidence-based guidelines. These updates help determine the medical necessity for the services provided to members that participate in these programs.

TurningPoint Healthcare Solutions, LLC contracts with us for the administration and utilization management review of certain orthopedic, spine and cardiac services for coverage. TurningPoint Healthcare Solutions, LLC is independent from, and not affiliated with, Horizon Blue Cross Blue Shield of New Jersey, Horizon NJ Health, or the Blue Cross Blue Shield Association.

ECN0028223A (1026)

Published on: November 2, 2026, 08:57 a.m. ET
Last updated on: November 2, 2026, 08:58 a.m. ET
Horizon Blue Cross Blue Shield of New Jersey published this content on November 02, 2026, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on November 02, 2026 at 14:54 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]