CommercialCoverageMedium impact
05.00.72h, Upper Limb Prostheses
Independence Blue Cross·Orthopedics, PM&R (Physical Medicine & Rehab), Plastic Surgery·Medical Policy
Effective date
Sep 3, 2025
We identified it
Jun 19, 2026
Summary
The Upper Limb Prostheses policy (05.00.72h) has been reissued for commercial plans with an effective date of September 3, 2025. This is a policy reissue rather than a substantive change, but billing teams should review the updated policy for any modifications to coverage criteria or billing requirements for upper limb prosthetic devices.
Action Required
Before September 3, 2025: Billing team must access the updated Upper Limb Prostheses policy at the source URL to review any changes to coverage criteria, prior authorization requirements, or documentation standards for upper limb prosthetic devices. Update billing procedures and staff training materials as needed based on policy changes identified in the full policy document.