Musculoskeletal preauthorization program

Musculoskeletal procedures—namely those dealing with knees, hips, shoulders, and spine—are frequent and costly. So we are doing something about them. Our innovative preauthorization program is designed to guide the right surgery for each patient.

Our musculoskeletal preauthorization program is supported by a team of doctors who can provide an expert-level review for specific surgeries. More specialized preauthorization reviews mean better outcomes, reduced costs, and safer surgeries.

This program can help your employees get through surgery and back to work feeling their best. Here’s how:

Better safety and quality for your employees

  • Appropriate use of the implanted device during surgery
  • Product recall and safety monitoring
  • Device manufacturing accountability
  • Evidence-based treatment plan management and interventions
  • Clinical transparency and measurement tools

Provider collaboration

  • Reduced administrative work for the provider
  • Pay-for-performance awards
  • Enhanced network support

Significantly reduced care costs

  • Site-of-service optimization
  • Lower device costs
  • Best implant for the patient’s health history and diagnosis
  • Appropriate use of the device

What procedures are covered?

  • Most knee surgeries
  • Most hip surgeries
  • Most shoulder surgeries
  • Most ankle surgeries
  • Most wrist surgeries
  • Most elbow surgeries
  • Most spine surgeries1

Contact your Capital Blue Cross account executive with any questions, or for a full list of covered surgeries.

1Select spinal procedure codes to be added as of January 1, 2019.