CommercialCoverageMedium impact
Orthotics - (Effective Date - 2026-08-17) 1.01.25
Excellus BlueCross BlueShield·Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy·Bone & Joints (Orthopedic)
Effective date
Aug 17, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their orthotics policy effective August 17, 2026, establishing clear criteria for medical necessity, repair, and replacement of orthotic devices. The policy specifically excludes certain advanced devices like electronic KAFO devices, myoelectric upper extremity orthotics, and powered exoskeletons as investigational.
Action Required
By August 17, 2026: Billing team must review all orthotic claims to ensure compliance with new medical necessity criteria. Update prior authorization processes to require detailed clinical documentation for custom orthotic devices. Train staff on coverage exclusions for electronic/electromagnetic KAFO devices, myoelectric upper extremity orthotics, and powered exoskeletons as these are now considered investigational. Update billing system to flag duplicate orthotic requests as not medically necessary.