Proposed knee brace LCD ‘big win,’ says AOPA
By HME News Staff
Updated 10:04 AM CDT, Mon July 28, 2025
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WASHINGTON – The DME MACs have released a draft revision to the Knee Orthoses Local Coverage Determination (LCD) and its corresponding Policy Article.
DL 33318 comes nearly two years after the American Orthotic and Prosthetic Association (AOPA) made a formal LCD reconsideration request.
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
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 AOPA has long argued that this outdated policy fails to reflect current clinical best practices.
“It’s a big win for patients,” Joe McTernan, director of health policy and advocacy for the American Orthotic & Prosthetic Association (AOPA), told HME News.
CMS will hold a public hearing on Aug. 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.
View the official documents:
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