CMS Publishes Final Rule that Defines Powered Orthoses and Exoskeletons as “Braces”

On November 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released its annual final rule that established 2024 payment rates for the Medicare Home Health Prospective Payment System (PPS).  As expected, the final rule carried forward several important, but unrelated provisions that are of significant interest to O&P providers and the Medicare beneficiaries they serve.  The DMEPOS provisions that were finalized in the rule include:

  • The codification and expansion of the Medicare definition of the term “brace” to include powered orthoses and exoskeletons
  • Creation of a new benefit category and payment for compression garments used to treat lymphedema
  • Changes to the methodology used to calculate Medicare fee schedules based on rates established through competitive bidding
  • Modifications to supplier enrollment processes designed to further control Medicare fraud and abuse
  • Codification of existing policy regarding documentation requirements for DMEPOS refills

The provision that will most likely have the greatest impact on the O&P profession is the inclusion of powered orthoses and exoskeletons in the brace benefit category for Medicare coverage and payment purposes.  This represents a reversal of the long-standing CMS position that powered orthoses and exoskeletons should be classified as durable medical equipment (DME) as they generated motion across a joint without necessarily supporting a weakened joint or body member.  AOPA and its O&P Alliance partners submitted detailed comments  on this proposed provision and is pleased that CMS decided to include this provision in the final rule.

In addition, the DME MACs recently informed AOPA that its LCD Reconsideration Request for knee orthoses used to treat osteoarthritis without joint laxity was a valid request and will be considered for update.  AOPA submitted its request on August 29th.  The DME MACs have 60 days to notify requestors of the validity of the request but have no defined timeline to complete their review and propose any changes to the LCD.  If the DME MACs propose changes to the LCD, they will publish them and schedule a public meeting to allow input from any interested parties.  We have been in frequent communication with the DME MAC Medical Directors regarding this request and look forward to working with them to create a coverage pathway moving forward.