Knee orthoses are covered under the Medicare braces benefit when coverage, documentation, and billing requirements are met. These items are intended to support a weak or deformed body member or restrict or eliminate motion in an injured or diseased knee and must be rigid or semi‑rigid to qualify for coverage.

Coverage criteria for knee orthoses vary by the type of brace and the beneficiary's clinical condition. In general, documentation must support that the beneficiary:

• Is ambulatory, and
• Has a condition such as knee instability, weakness, deformity, recent injury or surgery, or qualifying osteoarthritis, depending on the specific orthosis provided

Suppliers should refer to the Knee Orthoses Local Coverage Determination (LCD L33318) and related Policy Article A52465 for code‑specific coverage criteria and limitations.

Medical record documentation must support medical necessity and include relevant clinical findings from the treating practitioner. Depending on the HCPCS code billed, certain knee orthoses are subject to:

• Required Prior Authorization, and/or
• Face‑to‑Face Encounter and Written Order Prior to Delivery (WOPD) requirements

Suppliers are responsible for ensuring all required documentation is obtained and maintained in the supplier file prior to claim submission.

Correct coding is critical. Suppliers must ensure:

• The HCPCS code billed accurately reflects the type of knee orthosis provided
• Required modifiers (such as RT/LT and policy‑specific modifiers) are appended appropriately
• Claims meet all Medicare coverage, documentation, and billing rules to avoid denials

Knee orthoses remain a high‑review item in medical review and Comprehensive Error Rate Testing (CERT) findings. Suppliers are encouraged to review the applicable LCD, policy articles, and Orthotics webpage to ensure compliance and support accurate claim submission.