Priority Health Arthroplasty (Joint Replacement) prior authorization requirements (2026)
What Priority 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 commercial plans. Yes. Priority 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 Priority Health generally applies
Prior authorization required via TurningPoint (MSK program, live for DOS on/after 9/1/2024). TurningPoint's MSK list explicitly includes hip/knee/shoulder arthroplasty (partial/total/revision); criteria are TurningPoint's evidence-based clinical policies (reviewed annually by AAOS). Priority Health's own "Total Joint Replacement" policy was retired 9/2024 when this moved to TurningPoint. Exact thresholds are in the TurningPoint portal Policies tab.
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 Priority Health policy.
How to submit
- Method: prism → TurningPoint (myturningpoint-healthcare.com)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — TurningPoint Provider Guide — included MSK procedures (Priority Health) · effective 2024-09-01.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 Priority Health require prior authorization for Arthroplasty (Joint Replacement)?
Yes. Priority 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 Priority Health require to approve Arthroplasty (Joint Replacement)?
Prior authorization required via TurningPoint (MSK program, live for DOS on/after 9/1/2024). TurningPoint's MSK list explicitly includes hip/knee/shoulder arthroplasty (partial/total/revision); criteria are TurningPoint's evidence-based clinical policies (reviewed annually by AAOS). Priority Health's own "Total Joint Replacement" policy was retired 9/2024 when this moved to TurningPoint. Exact thr… Always confirm against the current Priority Health policy.
How long does a Priority Health prior authorization take?
Turnaround varies by plan and submission method. Check the Priority Health portal for current timeframes.
Submitting Arthroplasty (Joint Replacement) to Priority 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.