Cardiology preauthorization program
Capital offers an innovative cardiology preauthorization program designed to guide the best possible care for our members while balancing cost to best serve our customers.
Our cardiology preauthorization program is supported by a team of doctors who can provide an expert-level review for evidence-based care for specific surgeries and procedures. More specialized preauthorization reviews can mean better outcomes, reduced costs, and safer procedures. Here’s how:
- Better safety and quality for your employees.
- Appropriate evidence-based treatment plan management and interventions.
- Enhanced network support.
- Reduced care costs.
- Site-of-service optimization.
- Care based on patient’s health history and diagnosis.
What procedures are covered?
The following cardiac surgeries and procedures (including all associated partial, total, and revision surgeries) in both inpatient and/or outpatient settings:
- Coronary angioplasty/stenting.
- Coronary artery bypass grafting.
- Implantable cardioverter defibrillator.
- Internal cardiac monitoring.
- Leadless pacemaker.
- Non-coronary angioplasty/stenting.
- Pacemaker.
- Percutaneous left atrial appendage occluder.
- Peripheral revascularization.
- Revision or replacement of implanted cardiac devices.
- Valve replacement.
- Cardiac catheterization.
- Wearable cardiac defibrillator.
- Cardiac contractility modulation.
- Diagnostic coronary angiography.
- Peripheral diagnostic angiogram and venogram.
Medical policies
Here is more information about medical policies through TurningPoint.
Contact your Capital Blue Cross account executive with any questions.
On behalf of Capital Blue Cross, TurningPoint Healthcare Solutions LLC assists in the administration of our cardiology authorization program. TurningPoint Healthcare Solutions LLC is an independent company.