The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released its year-end webcast in which Peter Thomas, JD, said 2025 brought major policy improvements and new challenges for O&P practitioners, clinics, and patients.
Topics included:
New and Expanded Knee Orthoses Coverage
The Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Directors recently announced a new Local Coverage Determination (LCD L33318) expanding coverage of knee orthoses for Medicare beneficiaries with osteoarthritis, a condition not recognized for Medicare coverage for many years.
The proposed LCD was issued in the summer, and NAAOP and its O&P Alliance partners, particularly the American Orthotic and Prosthetic Association, which spearheaded this policy change, submitted comments supporting the new policy and urging it to be finalized.
Recently, the policy was published as a final LCD, almost identical to the proposed policy, Thomas said. The new coverage policy will be effective January 25, 2026.
Final Rule on DMEPOS Competitive Bidding
The improved osteoarthritis coverage policy was countered by the Centers for Medicare & Medicaid Services (CMS) publication of a final rule on November 28 renewing and expanding competitive bidding for off-the-shelf (OTS) orthotic devices, as well as other Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items, Thomas said. CMS expects to recompete certain OTS knee and back braces and expand competitive bidding to upper-limb OTS orthoses. The specific Healthcare Common Procedure Coding System codes subject to the next round of competitive bidding will be announced in late spring or early summer, according to the final rule.
Unfortunately, Thomas said, CMS has made changes to the bidding process and pricing methodology that compounds NAAOP’s concerns with this program. In particular, CMS intends to introduce “remote item delivery,” a system that will limit suppliers of OTS orthotics to ten or less suppliers across the country, he said. NAAOP commented on the proposed rule that reliance on regional and national orthotic suppliers would eliminate any hope of clinical care associated with this benefit and would disrupt relationships between Medicare patients and community-based orthotists.
To view a webinar NAAOP hosted on this topic, visit the NAAOP website.
Annual Accreditation for DMEPOS Suppliers
CMS also issued a final rule accelerating the schedule for Medicare DMEPOS accreditation (and unannounced site visits) from every three years to annually. This is a major new burden on O&P providers that will increase accreditation costs and burdens with limited upside benefits to the program. CMS will stagger the implementation of this new policy to begin when an O&P provider’s existing accreditation status expires, delaying the impact of this policy for two or three years for many O&P clinics.
Thomas said NAAOP opposed this policy in its comments to the proposed rule, but CMS ignored the multitude of stakeholders who spoke against the policy. NAAOP will continue to closely monitor this situation and seek to lessen its negative impacts, he said.
To view the latest webcast, visit NAAOP’s website or its YouTube page.
