Private insurance policy information
Below are links to many of the BlueCross and/or BlueShield (BCBS) and other large commercial medical coverage policy web sites. To locate policies, use the search function and search for specific terms (e.g. microprocessor, myo, prosthetic, prosthesis, AFO, brace, wheelchair, seating, stander, etc.) into the search function.
Note: These policies may not apply to all lines of business such as the Federal Employee Program, Medicare Advantage, and certain self-insured groups. Additionally, definition of the terms “medical necessity” and “investigational” may vary from plan to plan.
The product/device “Supplier” (defined as an O&P practitioner, O&P patient care facility, or DME Supplier) assumes full responsibility for accurate billing of Ottobock products. It is the Supplier’s responsibility to determine medical necessity; ensure coverage criteria is met; and submit appropriate HCPCS codes, modifiers, and charges for services/products delivered. It is also recommended that Supplier’s contact insurance payer(s) for coding and coverage guidance prior to submitting claims. Ottobock Coding Suggestions and Reimbursement Guides are based on reasonable judgment and are not recommended to replace the Supplier’s judgment. These recommendations may be subject to revision based on additional information or alpha-numeric system changes.
Anthem BCBS (CA, CO, CN, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI, VA; Empire BCBS NY, NJ & CT) Search Medical Policies & Utilization Management
BCBS National Association (contains links to all BCBS organizations)
HMSA (BCBS Hawaii)
HCSC (BCBS IL, NM, TX, & OK)
NY Excellus BCBS (Central NY, Utica-Watertown, NY Rochester)
United HealthCare (Document Title – “Specialized Microprocessor or Myoelectric Limb”)