CommercialCoverageHigh impact
Durable Medical Equipment Standard and Non-Standard 1.01.00
Excellus BlueCross BlueShield·Durable Medical Equipment & Supplies
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their Durable Medical Equipment (DME) and medical devices policy, establishing comprehensive criteria for coverage, repair, and replacement of standard and non-standard equipment. The policy requires physician orders, medical necessity documentation, and restricts duplicate equipment coverage.
Action Required
By August 21, 2025: Billing team must update DME authorization processes to ensure all requests include physician documentation with equipment initiation dates, manufacturer warranty information, and compliance attestations. Update prior authorization workflows to verify equipment meets all seven standard DME criteria (medically useful, not useful without illness, physician ordered, home use, durable, reusable, provides therapeutic benefits). Train staff to identify and deny duplicate equipment requests as not medically necessary. Update repair/replacement claim reviews to require adequate function documentation and exclude coverage for neglect, theft, or abuse-related damage.