Revisions have finalized for the Knee Orthoses Local Coverage Determination (LCD) L33318 and its related Policy Article (A52465). These updates expand coverage for knee braces, particularly for patients with osteoarthritis, and align policy with current clinical practice. The change followed a reconsideration process and public comment period, incorporating feedback from clinicians, suppliers, and advocacy groups.

Under the new guidance, knee orthoses are covered not only for instability but also for osteoarthritis when patients are ambulatory, and documentation shows pain or functional impairment. Coverage applies if the orthosis provides varus or valgus adjustment, and the patient is willing to use the device. Practitioners must ensure medical records clearly demonstrate diagnosis, limitations, and expected benefit.

This revision is considered a significant step forward for patient access, correcting a long-standing gap in Medicare coverage. By recognizing orthoses as a valid treatment for osteoarthritis, the policy improves mobility and pain management options for Medicare beneficiaries.

You can review the LCD and Policy Article on our Active LCDs webpage.