We’re excited to share an important and encouraging development in Medicare policy—one that reflects both a significant advocacy victory and the strength of AOPA’s collaborative relationship with the DME MACs.
After nearly two years of persistent engagement following AOPA’s formal LCD reconsideration request, the DME MACs have released a draft revision to the Knee Orthoses Local Coverage Determination (LCD) and its corresponding Policy Article. This proposed update represents a major step forward in correcting one of the most significant omissions in Medicare coverage: orthotic treatment for osteoarthritis (OA) of the knee.
Why This Matters: Historically, Medicare coverage for knee orthoses required a history of recent knee injury or surgery, or documentation of joint instability. This meant that “unloader” braces—clinically proven to alleviate OA symptoms—were consistently denied as not medically necessary. AOPA has long argued that this outdated policy fails to reflect current clinical best practices.
In August 2023, AOPA’s Coding & Reimbursement Committee submitted a comprehensive LCD reconsideration request backed by robust clinical evidence. Since then, AOPA’s policy team has maintained open lines of communication with the DME MAC Medical Directors, advocating tirelessly for change. We’re proud to see that advocacy come to fruition.
What the Proposed LCD Covers: Under the new draft policy, Medicare would cover knee orthoses for medial or lateral tibiofemoral osteoarthritis without requiring joint instability, so long as the following are met and appropriately documented:
- The patient is ambulatory
- The patient is experiencing pain or functional impairment due to OA
- The knee orthosis provides varus or valgus adjustment
- The patient expresses a willingness to use the orthosis
View the official documents:
Next Steps: A public hearing will be held by CMS on August 27, 2025, and AOPA will participate to ensure member interests are represented. AOPA’s Policy Team and Coding & Reimbursement Committee are reviewing the proposed LCD in full and will submit formal comments as needed.
A big thank the AOPA Coding & Reimbursement Committee and our incredible staff—Joe McTernan and Devon Bernard—whose expertise and persistence helped bring this forward.
If you have questions or input you’d like to share ahead of the hearing or in relation to the draft policy, please reach out directly to Joe at jmcternan@AOPAnet.org or Devon at dbernard@AOPAnet.org.
Thank you for your continued support—together, we’re shaping the future of O&P policy.