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Prostheses to Require Authorization

We continue to be committed to making health care more affordable, and part of that commitment means ensuring the appropriate use of health care services. In keeping with these efforts and industry standards, we will require prior authorization for certain kinds of upper and lower limb prostheses, in order to be sure they are medically necessary. The changes are outlined below:

  • New policy is effective September 1, 2010
  • Authorization is required for our managed care products (excluding
    Medicare HMO BlueSM) for the following services:
    • Myoelectric prosthesis for the upper limb
    • Microprocessor controlled prostheses for the lower limb

If you have any questions about coverage for prosthetic devices, these specific services, or the prior authorization process, please contact your account executive.

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