Prolotherapy - (Effective Date - 2026-10-15) 8.01.10

By October 15, 2026: Billing team must implement the following: (1) Update billing software to automatically flag and deny all prolotherapy claims submitted under Excellus BCBS plans; (2) Create a denial reason code in the system referencing Policy 8.01.10 - Investigational Service; (3) Update claim submission protocols to require providers to document 'investigational procedure' disclaimers at point of service; (4) Notify all orthopedic, rheumatology, pain management, and sports medicine providers in network of non-coverage status; (5) Add prolotherapy to the patient-facing 'non-covered services' list on patient intake forms; (6) Train front-desk and billing staff on the investigational status so they can inform patients of out-of-pocket responsibility before scheduling. Failure to implement these changes will result in claims being processed and then denied, creating revenue cycle delays and patient billing disputes. Before the effective date, conduct a retroactive audit of any prolotherapy claims billed in the prior 12 months under this payer to identify potential recoupment exposure.