Horizon BCBS NJ Hip Osteotomy prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve Hip Osteotomy (CPT 27146, S2115), for PPO plans. Yes. Horizon BCBS NJ generally requires prior authorization for Hip Osteotomy (CPT 27146, S2115).
Medical-necessity criteria Horizon BCBS NJ generally applies
Prior authorization required; managed by TurningPoint Healthcare Solutions (Horizon Surgical & Implantable Device Management Program, orthopedic). Binding TurningPoint OR criteria are portal-only [SPOT-CHECK]. NOTE: the Carelon Joint Surgery guideline does NOT cover hip/pelvic osteotomy codes, so it is not the proxy here; the public evidence-based proxy is Aetna CPB 0736 (Hip Preservation Surgery), which enumerates these codes. Periacetabular/hip osteotomy is generally medically necessary for symptomatic acetabular dysplasia when (proxy criteria): lateral center-edge angle (LCEA) under 20 degrees and/or Tonnis (acetabular index) angle over 12 degrees; no more than mild osteoarthritis (Tonnis grade 0 or 1); symptoms for at least 6 months; age under 45 and skeletally mature; and failed/inadequate conservative management. All thresholds are Aetna-proxy, NOT Horizon-binding [NEEDS VERIFICATION].
Related procedure codes
Codes often billed alongside Hip Osteotomy: 27146, S2115. Verify the correct codes for your documentation.
Commonly required documentation
- Imaging with measured LCEA / Tonnis (acetabular index) angle and documented Tonnis OA grade
- symptom duration
- documented conservative care (NSAIDs, PT, activity modification) and response
- skeletal-maturity confirmation
- operative plan. Exact TurningPoint checklist is portal-only [SPOT-CHECK].
Situations to verify before submitting
Horizon BCBS NJ may not cover Hip Osteotomy in these situations. Verify against the current policy rather than assuming a denial:
- Moderate or worse osteoarthritis (Tonnis grade 2 or 3) - not medically necessary (total hip arthroplasty pathway instead)
- Asymptomatic dysplasia
How to submit
- Method: portal
- Portal: TurningPoint Healthcare Solutions Web Portal
Sources & verification
- Portal-onlyTurningPoint — Horizon Surgical & Implantable Device Management Program (TurningPoint), orthopedic.View
- ProxyPayer medical policy — Aetna CPB 0736 - Hip Preservation Surgery (public evidence proxy; Carelon does not cover osteotomy) (CPB 0736).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 2026-06-20.
Frequently asked questions
Does Horizon BCBS NJ require prior authorization for Hip Osteotomy?
Yes. Horizon BCBS NJ generally requires prior authorization for Hip Osteotomy (CPT 27146, S2115).
What does Horizon BCBS NJ require to approve Hip Osteotomy?
Prior authorization required; managed by TurningPoint Healthcare Solutions (Horizon Surgical & Implantable Device Management Program, orthopedic). Binding TurningPoint OR criteria are portal-only [SPOT-CHECK]. NOTE: the Carelon Joint Surgery guideline does NOT cover hip/pelvic osteotomy codes, so it is not the proxy here; the public evidence-based proxy is Aetna CPB 0736 (Hip Preservation Surgery)… 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 Hip Osteotomy 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.