D-SNP Medical Coverage Policy: Upper Limb Prosthetics

In June 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) implemented an updated Medicare Upper Limb Prosthetics policy for all Blue Medicare HMO^℠, Blue Medicare PPO^℠, Healthy Blue + Medicare^℠ (HMO-POS D-SNP), Blue Medicare Rx^℠ members, and members of any third-party Medicare plans supported by Blue Cross NC through administrative or operational services.

Effective January 1, 2026, this policy also applies to Dual Eligible Special Needs Plan (D-SNP) members.

Blue Cross NC is noticing this policy to comply with CMS mandates regarding the Plan implementing internal Medical Policies in the absence of National Coverage Determinations (NCD) or Local Coverage Determinations (LCD) coverage criteria.

Blue Cross NC will provide coverage for Upper Limb Prosthetics services when it is deemed medically necessary in accordance with best practice standards, which are detailed within the policy. Please see the full policy, Upper Limb Prosthetics, for more information.