CommercialCoverageMedium impact
Limb Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis 1.01.51
Excellus BlueCross BlueShield·Orthopedics, General Surgery, Vascular Surgery·Durable Medical Equipment & Supplies
Effective date
Sep 18, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new coverage criteria for pneumatic compression devices for VTE prophylaxis, limiting coverage to post-major surgery use (including orthopedic procedures) when blood thinners are contraindicated, with a 30-day maximum duration. All other uses are considered not medically necessary.
Action Required
Before September 18, 2025: Billing team must update prior authorization workflows for pneumatic compression device claims to verify three requirements: 1) Use after major surgery (including hip/knee replacement, hip fracture surgery), 2) Documentation that blood thinners are contraindicated due to bleeding risk, and 3) Post-surgical use limited to 30 days maximum. Claims not meeting all criteria will be denied as not medically necessary.