CommercialCoverageMedium impact
05.00.72i, Upper Limb Prostheses
Independence Blue Cross·Orthopedics, PM&R (Physical Medicine & Rehab), Plastic Surgery·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
The Upper Limb Prostheses medical policy (05.00.72i) has been updated for commercial insurance plans, effective October 1, 2025. This policy change affects coverage criteria and billing requirements for upper extremity prosthetic devices and related services.
Action Required
By October 1, 2025: Billing team must review the updated Upper Limb Prostheses policy 05.00.72i at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx to understand any changes to coverage criteria, prior authorization requirements, or documentation standards for upper limb prosthetic devices. Update billing procedures and staff training accordingly for all commercial plan claims.