MUSCULOSKELETAL AND CARDIAC SURGICAL PROCEDURES
CareSource® covers both musculoskeletal and cardiac surgeries for our members. Orthopedic, Neuro-Spine and Cardiac providers can access the following tools to help them provide efficient and quality care.
Policies
Providers can view clinical guidelines being used by CareSource at www.myturningpoint-healthcare.com. Providers will initially be asked to “Register for Access”. Upon registration, providers will be able to log into the provider portal and select the POLICIES section to view and/or download these clinical guidelines as PDF documents. Musculoskeletal and Cardiac procedures will require prior authorization for medical necessity and will be reviewed by TurningPoint Healthcare Solutions, LLC for adherence and consistency with these clinical guidelines, as well as industry standardized rules. The review will include evaluation of services for being experimental and/or investigative, as well as clinical appropriateness based upon patient demographic information.
Providers may also request copies of these clinical guidelines directly from TurningPoint by calling their Provider Relations team at the number listed below, or by emailing providersupport@turningpoint-healthcare.com.
| Local Phone | Toll Free Phone | Local Fax | Toll Free Fax | |
|---|---|---|---|---|
| Georgia Providers | (380) 203-2125 | (855) 927-1815 | (614) 441-8649 | (844) 472-0485 |
Prior Authorization & Provider Portal
Portal providers and/or their delegates should follow Georgia Department of Community Health’s (DCH) guidelines to submit prior authorization requests and supporting documentation through the Georgia Medicaid PNM Portal.
CARDIAC SURGERIES & PROCEDURES | Including all associated partial, total, and revision surgeries
- Cardiac Nuclear Medicine
- Duplex Scan Extracranial Arteries
- Echocardiogram
- Peripheral Diagnostic Testing
- Cardiac Catheterization
- Cardiac Contractility Modulation
- Coronary Angioplasty/Stenting
- Implantable Cardioverter Defibrillator
- ICD Revision or Removal
- Pacemaker
- Pacemaker Revision or Removal
- Peripheral Revascularization
- Coronary Artery Bypass Grafting
- Internal Cardiac Monitoring
- Leadless Pacemaker
- Left Atrial Appendage (LAA) Occluders
- Non-Coronary Angioplasty/Stenting
- Pulmonary Artery Pressure Monitoring
- Valve Replacement
- WCD – Wearable Cardiac Defibrillator
MUSCULOSKELETAL SURGERIES & PROCEDURES | Orthopedic Surgical Procedures – Including all associated revision surgeries | Spinal 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
- Hip Arthroscopy
- Femoroacetabular Arthroscopy
- Meniscal Repair (with or w/o allograft)
- Ankle Fusion
- Shoulder Fusion
- Wrist Fusion
- Osteochondral Defect Repair
- Disc Replacement
- Laminectomy/Discectomy
- Kyphoplasty/Vertebroplasty
- Sacroiliac Joint Fusion
- Implantable Pain Pumps
- Spinal Cord Neurostimulator
- Spinal Decompression
- Spinal Fusion Surgeries
- Cervical
- Lumbar
- Thoracic
- Sacral
- Scoliosis
Note: These lists are not all-inclusive and are subject to change.
Updates & Announcements
Our goal is to keep you informed with timely information about our plan and services. As changes occur and as needs arise, we issue network notifications providers via the CareSource Updates & Announcements webpage.
Please check these pages often to learn about updates and changes that impact your practice.
Contact Us
If you have questions, please contact CareSource’s Provider Services at 1-855-202-1058. Our hours of operation are Monday through Friday, 7 a.m. – 7 p.m. Eastern time (ET).