End of Year Brings Victories and Challenges to the O&P Community

The end of the year brought major policy improvements and new challenges for O&P practitioners, clinics and patients as CMS made significant announcements.

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New and Expanded Knee Orthoses Coverage:  The 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 this past summer and NAAOP and its O&P Alliance partners, particularly the American Orthotic Prosthetic Association, which spearheaded this policy change, submitted comments supporting the new policy and urging it to be finalized as expeditiously as possible.  Recently, the policy was published as a final LCD, almost identical to the proposed policy.  The new coverage policy is effective January 25, 2026, and should provide Medicare beneficiaries with osteoarthritis in the knees significantly improved access to orthotic care.  The new policy can be access here. 

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Final Rule Issued on DMEPOS Competitive Bidding:  Unfortunately, the improved osteoarthritis coverage policy was countered by CMS’s publication of a final rule on November 28th renewing and expanding competitive bidding of off-the-shelf (“OTS”) orthotics, as well as other DMEPOS.  CMS expects to recompete certain OTS knee and back braces and expand competitive bidding to upper extremity OTS orthoses.  The specific HCPCS codes subject to the next round of competitive bidding will be announced in late Spring or early Summer, according to the final rule.  Unfortunately, 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 so-called “RID” system that will limit suppliers of OTS orthotics to ten or less suppliers across the country of knee, back, and upper extremity orthotics.  NAAOP commented to 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.  NAAOP hosted a webinar on this topic on December 15th that can be accessed on the NAAOP website at www.naaop.com. 

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Annual Accreditation for DMEPOS Suppliers is Coming Soon:  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.  Stimulated by fraud and abuse in the Medicare DMEPOS benefit, 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.  NAAOP opposed this policy in its comments to the proposed rule, but CMS ignored the multitude of stakeholders who spoke against the policy, urging CMS to not finalize the rule.  NAAOP will continue to closely monitor this situation and seek to lessen its negative impacts. 

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NAAOP thanks its members and friends for all the support through the year and wishes everyone a happy and healthy holiday season.  We look forward to a busy and productive new year.