BCBS Minnesota’s Interventions for Progressive Scoliosis Policy has been updated. Effective for dates of service on or after January 1st, 2025, the statement “Custom fabricated orthoses for the treatment of scoliosis created by 3-D or CAM-CAD technologies(i.e., Rigo, Cheneau) is considered investigational” is no longer in present in the policy. The same update is seen in BCBS Alabama’s Commercial Policy.

UPDATE (1/30/2025): More policy changes seen resulting from So Every BODY Can Move Legislation

(Commercial Plan) UCARE’s Medical Equipment policy for Individual and Family Plans now explicitly states:

  • Prosthetics includes coverage of, but is not limited to:
     Orthosis, orthotics, prosthesis, and prosthetics devices, supplies, and services, custom
    fit devices, evaluation, analysis, treatment, periodic evaluation, etc.
     Devices that meet the medical needs for performing physical activities for the best
    quality of life and mobility
    o Needs such as swimming, biking, running and/or
    o Devices for showering or bathing.

Minnesota Medicaid (FFS) – Orthotics – Medical Policy, reads:

“Minnesota Health Care Programs (MHCP) covers orthotic and prosthetic devices, supplies, and services that are medically necessary and prescribed by a physician or licensed health care prescriber who has authority in Minnesota to prescribe orthoses and prostheses, including devices customized to the member’s needs. MHCP covers an additional orthotic and prosthetic device for all MHCP members for purposes of bathing or showering. For eligible members, MHCP also covers an orthotic and prosthetic device for purposes of performing physical activities including, but not limited to, running, biking, swimming, and maximizing the enrollee’s limb function. Devices for purposes of bathing or showering do not require prior authorization unless the member already has devices for both everyday use and recreation. Prior authorization is required for devices for recreational purposes”

The first version of this Medicaid policy with this wording was in July, shortly after the SEBCM legislation passed.

UPDATE (1/10/2025): As a result of Minnesota’s recently-enacted So Every BODY Can Move legislation, changes to policy are already being seen! Blue Cross Blue Shield of Minnesota’s commercial policies around Myoelectric Prosthetic and Orthotic Components for the Upper Limb and Microprocessor-Controlled Prostheses for the Lower Limb have been updated with similar language changes. Below are examples of the changes within the Myoelectric Prosthetic and Orthotic Components for the Upper Limb policy.

Under the previous policy BCBS Minnesota deemed myoelectric upper limb prostheses and orthotic components as not medically necessary for the following reasons:

  • Patient does not meet medical necessity criteria in Section I of the policy Duplication or upgrade of a functional prosthesis
  • Repair or replacement of parts for a duplicate myoelectric upper limb prosthesis
  • Myoelectric upper limb prosthesis or additions/components not required for participation in normal activities of daily living, including but not limited to those that:
    • Are chiefly for convenience including participation in recreational activities
    • Exceed the medical needs of the patient (e.g., back-up prosthetic device or waterproof prosthesis)
  • Repair or replacement of a myoelectric upper limb prosthesis for any of the following:
    • Appearance or convenience
    • Malicious damage or neglect
    • Use in environments that limit functional life of the device (e.g., excessive moisture, dust or other conditions not recommended by manufacturer)

The updated policy expands coverage for myoelectric upper limb prostheses and orthotic components when ALL of the following conditions are met:

  • The individual has an amputation or missing limb at the wrist or above (e.g., forearm, elbow, shoulder); AND
  • Standard body-powered prosthetic devices cannot be used or are insufficient to meet the functional needs of the individual (e.g., gripping, releasing, holding, and coordinating movement of the prosthesis); AND
  • The remaining musculature of the arm(s) contains the minimum microvolt threshold to allow operation of a myoelectric prosthetic device; AND Meets requirements of the device specified by the manufacturer; AND
  • The individual has demonstrated sufficient neurological and cognitive function to operate the prosthesis effectively; AND
  • The individual is free of comorbidities that could interfere with function of the prosthesis (e.g., neuromuscular disease); AND
  • Functional evaluation indicates that with training, use of a myoelectric prosthesis is likely to meet the maximum functional mobility and/or physical activity needs of the individual (e.g., ADLs, running, biking, swimming). This evaluation should consider the individual’s needs for control, durability (maintenance), function (speed, work capability), and usability.

This is a direct result of the So Every BODY Can Move legislation recently enacted in Minnesota. It’s exciting to see the impact of the legislation already taking effect in policies, increasing access to orthotic and prosthetic care!