Changes to Knee Orthoses LCD and PA Finalized

What You Need to Know

The DME MACs have finalized changes to the Knee Orthoses LCD that will permit suppliers to provide these devices to patients with osteoarthritis in the absence of objective evidence of joint laxity,  subject to certain requirements. This represents a significant shift in policy, as the current LCD requires objective documentation of joint laxity as a prerequisite to fit an OA brace. 

The updated LCD offers the following alternative to the current joint laxity requirement:

A single or double-upright brace described by L1843, L1845, L1851, and L1852 is covered if the beneficiary has a documented diagnosis of medial or lateral tibiofemoral osteoarthritis and meets the following criteria:

1. The beneficiary is ambulatory; and
2. The beneficiary is experiencing pain or a reduction in their mobility and/or function secondary to the medial or lateral tibiofemoral osteoarthritis; and
3. The knee orthosis provides either varus or valgus adjustment; and,
4. The beneficiary expresses a willingness to use the knee orthosis.

The updated Policy Article further spells out documentation requirements, stating that the beneficiary's medical record must include all of the following:

1. The beneficiary's ambulatory status; and
2. The beneficiary's pain symptoms, or mobility and/or functional reduction due to the medial or lateral tibiofemoral osteoarthritis; and
3. A physical examination of the beneficiary's affected knee(s); and
4. An imaging report (e.g., x-ray, CT scan, MRI) that describes arthritic changes (e.g., joint space narrowing, bone spurs, cysts) consistent with medial or lateral compartment tibiofemoral osteoarthritis; and
5. The beneficiary's willingness to use the knee orthosis.

In its published response to comments about the draft LCD and PA, the DME MACs specifically noted that either the treating practitioner or the orthotist/prosthetist can document the beneficiary's willingness to use the knee orthosis.

The updated LCD and PA become effective on January 25th, 2026.

What This Means for You

For years, physicians, certified/licensed orthotists, and DME companies have noted that OA can present without objective evidence of joint laxity. However, the LCD's current requirement prevented some patients who could benefit from the pain-reducing/mobility-enhancing effects of OA knee braces from getting them. Beginning on January 25, 2026, the updated LCD and PA will increase access to these devices so long as the provider treating the patient can satisfy the requirements listed above.

Between now and January 25th, the existing standard requiring an objective showing of joint laxity for the orthotic treatment of osteoarthritis remains in effect. But you should begin training both clinical and billing staff ahead of the January 25th effective date so that practitioners and claims specialists are familiar with the new standards and document findings in the medical record consistent with them.

You can access the pending LCD here and the pending Policy Article here.