CommercialCoverageMedium impact
Orthotics 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 updated their orthotics policy effective August 17, 2026, defining medical necessity criteria for orthotic devices including AFOs, LSOs, TLSOs, and KAFOs. The policy clarifies that custom orthotics require detailed clinical documentation when standard devices cannot perform activities of daily living, and certain electronic/powered devices are considered investigational.
Action Required
Before August 17, 2026: Billing team must update prior authorization processes to ensure detailed clinical documentation is submitted for custom orthotic devices when standard devices are inadequate for activities of daily living. Flag electronic/electromagnetic KAFO devices, myoelectric upper extremity orthotics, and powered exoskeleton devices as investigational (non-covered). Update encounter forms to remind providers that sports/work-only orthotics and duplicate orthotics per body part are not covered.