The Centers for Medicare & Medicaid Services and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) recently released a final revision to the Knee Orthoses Local Coverage Determination (LCD) and corresponding Policy Article, which take effect January 25, 2026.
The LCD proposes modifications to the coverage criteria for knee orthoses with single or double upright, adjustable flexion and extension joint, medial-lateral and rotation control, with varus/valgus adjustment for the management or treatment of ambulatory Medicare beneficiaries with pain or reduction in mobility and/or function due to medial or lateral tibiofemoral osteoarthritis (OA). According to the LCD, Medicare will cover knee orthoses for this patient population without requiring joint instability if the following criteria are met and documented: (1) the patient is ambulatory, (2) the patient is experiencing pain or functional impairment due to OA, (3) the knee orthosis provides varus or valgus adjustment, and (4) the patient expresses a willingness to use the orthosis.
To read the LCD, visit www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33318. To read the Policy Article, visit www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52465&ver=70 .
