On July 24, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a draft revision to the Knee Orthoses Local Coverage Determination (LCD) allowing for changes to the prescription of some knee braces to treat osteoarthritis (OA).
Policies set by the Centers for Medicare & Medicaid Services have led to denials of unloader knee braces to treat OA without documentation of joint instability or a history of recent knee injury or surgery despite the devices being clinically proven to alleviate OA symptoms.
In the revision, the DME MACs wrote that “there is sufficient evidence to support that the use of unloader knee braces may be a potential nonsurgical therapeutic option for the reduction of pain or improvement in mobility and/or function in some Medicare beneficiaries with a diagnosis of medial or lateral unicompartmental knee OA, regardless of the presence of objective joint laxity.”
Under the proposed LCD, Medicare would cover knee orthoses for medial or lateral tibiofemoral OA without requiring joint instability, under the following conditions:
- 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 American Orthotics and Prosthetics Association (AOPA) released a statement in support of the revision after its “persistent engagement” with the DME MACs on the topic. In 2023, AOPA’s Coding and Reimbursement Committee submitted the LCD reconsideration request. AOPA said it has long argued that the outdated policy failed to reflect current clinical best practices.
“This proposed update represents a major step forward in correcting one of the most significant omissions in Medicare coverage,” AOPA said.
To read the revision, visit “Proposed LCD-Knee Orthoses (DL33318)” and the “Draft KO Policy Article.”
To learn more about the public hearing being held August 27, visit “DME MACs Hosting Knee Orthosis LCD Public Meeting.”
