BCBS Coverage for Knee Braces
Yes, Blue Cross Blue Shield covers knee braces as durable medical equipment (DME) when medically necessary and prescribed by a physician.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes (as DME) |
| Prescription Required | Yes |
| Prior Authorization | For custom braces |
| Network | In-network saves money |
Types of Braces Covered
| Brace Type | Coverage | Typical Cost to You |
|---|---|---|
| Basic knee sleeve | Yes | $5-$20 |
| Hinged brace | Yes | $25-$75 |
| Unloader brace | Yes (with documentation) | $80-$250 |
| Custom brace | Yes (may need PA) | $100-$400 |
How to Get a Brace Covered
Step 1: Get a Prescription
Your doctor must provide a written order including:
- Diagnosis
- Type of brace needed
- Medical necessity statement
Step 2: Use In-Network Supplier
- Check BCBS DME supplier network
- Get cost estimate before ordering
- Confirm coverage with supplier
Step 3: Obtain Your Brace
- Supplier bills BCBS directly
- You pay your cost-sharing amount
Cost-Sharing Examples
| Plan Type | Your Cost |
|---|---|
| PPO (in-network) | 20% coinsurance |
| HMO | $20-$50 copay |
| High-deductible | Full cost until deductible met |