Braven Health Arthroplasty (Joint Replacement) prior authorization requirements (2026)
What Braven Health generally requires to approve Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118).
Medical-necessity criteria Braven Health generally applies
Prior authorization required — joint replacement (hip/knee/shoulder) falls under the TurningPoint Surgical & Implantable Device Management Program (Orthopedic Services), with Braven Health explicitly in scope. Documented standard: appropriate conservative therapies must be attempted before surgery; submission requires HPI, conservative-therapy/PT notes, radiographic findings, and a documented surgical plan. Exact numeric thresholds (BMI cutoff, weeks of conservative care) live in TurningPoint's medical-policy library (portal) — confirm there.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Arthroplasty (Joint Replacement). Confirm the covered diagnosis list against the current Braven Health policy.
How to submit
- Method: TurningPoint (Availity / portal / 1-833-436-4083)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Surgical & Implantable Device Management Program — Orthopedic Services (Braven in scope).View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does Braven Health require prior authorization for Arthroplasty (Joint Replacement)?
Yes. Braven Health generally requires prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118).
What does Braven Health require to approve Arthroplasty (Joint Replacement)?
Prior authorization required — joint replacement (hip/knee/shoulder) falls under the TurningPoint Surgical & Implantable Device Management Program (Orthopedic Services), with Braven Health explicitly in scope. Documented standard: appropriate conservative therapies must be attempted before surgery; submission requires HPI, conservative-therapy/PT notes, radiographic findings, and a documented surg… Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting Arthroplasty (Joint Replacement) to Braven Health?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.