CMS Policy Article Updates: Custom Fit Documentation
What You Need to Know
On April 9, 2026, the DME MACs updated the AFO/KAFO, Knee Orthoses, and Spinal Orthoses Policy Articles. In all three articles, they made the following change related to custom fit devices:
Original verbiage: “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary.”
Revised verbiage: “Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary." [emphasis added]
What This Means for You
This update does not introduce a new requirement but rather clarifies the documentation required to support coverage for a custom fit device. Along with explaining what modifications you made beyond "minimal self-adjustment," you also need to document why those modifications were medically necessary for the proper fit and function of the orthosis. For example, describe any unique anatomy the patient has and explain why the modifications were necessary to accommodate, support, and/or correct the patient's presentation. If Medicare does not believe that the modifications you made were medically necessary for your patient, they will likely deny the claim as improper coding. This update continues to highlight the importance of proper documentation to prevent claim denials.
Use the following links to review the complete updated Policy Articles:
For more detailed documentation advice, you can also review our previous R&R post on Custom Fit Orthoses.