Horizon BCBS NJ Hammertoe Correction prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve Hammertoe Correction (CPT 28285, 28286), for Commercial plans. Yes. Horizon BCBS NJ generally requires prior authorization for Hammertoe Correction (CPT 28285, 28286).
Medical-necessity criteria Horizon BCBS NJ generally applies
Prior authorization / medical-necessity determination (PA/MND) required for orthopedic surgical procedures under Horizon's Surgical and Implantable Device Management Program, administered by TurningPoint Healthcare Solutions - participating AND nonparticipating physicians must obtain PA/MND for members in participating plans. Confirm this specific CPT code on Horizon's Prior Authorization Procedure Search Tool before scheduling (code lists are maintained by TurningPoint and change). [NEEDS CLINICAL SPOT-CHECK]
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Hammertoe Correction. Confirm the covered diagnosis list against the current Horizon BCBS NJ policy.
Commonly required documentation
- Clinical notes supporting medical necessity per TurningPoint's published medical-policy criteria for the procedure (conservative care history, imaging, functional impact).
How to submit
- Method: Request PA/MND through the TurningPoint provider portal; status confirmation by phone 1-833-436-4083 (Mon-Fri 8am-5pm ET).
- Portal: TurningPoint
Sources & verification
Source: Horizon BCBS NJ Surgical and Implantable Device Management Program pages (horizonblue.com, verified 2026-07-10) - TurningPoint conducts PA/MND for orthopedic services. Podiatric-procedure inclusion should be confirmed against the current TurningPoint code list / Horizon PA search tool. Last verified 2026-07-10.
Frequently asked questions
Does Horizon BCBS NJ require prior authorization for Hammertoe Correction?
Yes. Horizon BCBS NJ generally requires prior authorization for Hammertoe Correction (CPT 28285, 28286).
What does Horizon BCBS NJ require to approve Hammertoe Correction?
Prior authorization / medical-necessity determination (PA/MND) required for orthopedic surgical procedures under Horizon's Surgical and Implantable Device Management Program, administered by TurningPoint Healthcare Solutions - participating AND nonparticipating physicians must obtain PA/MND for members in participating plans. Confirm this specific CPT code on Horizon's Prior Authorization Procedur… Always confirm against the current Horizon BCBS NJ policy.
How long does a Horizon BCBS NJ prior authorization take?
Turnaround varies by plan and submission method. Check the Horizon BCBS NJ portal for current timeframes.
Submitting Hammertoe Correction to Horizon BCBS NJ?
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.