AOPA is excited to share an important development in Medicare policy. After nearly two years of persistent engagement following our initial formal LCD reconsideration request in 2023, the DME MACs have released the final revision to the Knee Orthoses Local Coverage Determination (LCD) and its corresponding Policy Article. This 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 (KO) required a record of recent knee injury or surgery, or documentation of joint instability. This meant that “unloader” style braces—clinically proven to alleviate OA symptoms—were consistently denied as not medically necessary. AOPA has long argued that this policy failed to reflect current clinical best practices.
What the Revised LCD Covers: Under the revised policy, Medicare will 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
The new Knee Orthoses LCD will be effective for claims with a date of service on or after January 25, 2026.
View the official documents:
Please stay tuned as AOPA provides more guidance and education on the KO LCD revisions.
If you have questions, please reach out directly to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.