New Policy Improves Access and Aligns With Clinical Best Practices
The Centers for Medicare & Medicaid Services (CMS) has issued a significant update to its Knee Local Coverage Determination (LCD) policy, effective January 25, 2026. This revision impacts coverage for knee orthoses and introduces expanded criteria and streamlined documentation requirements.
Key highlights of the policy update include:
- Expanded Eligibility: Knee braces will now be covered for patients experiencing pain or reduced mobility and/or function due to medial or lateral tibiofemoral osteoarthritis (OA), even if joint laxity is not present.
- New Diagnosis Codes: Tibiofemoral OA will be recognized as a distinct category, with specific coverage guidelines to address previous gaps.
- Alignment With Clinical Standards: The changes reflect current best practices and support conservative, non-surgical treatment options for improved patient outcomes.
Patients will benefit from improved access to bracing for knee osteoarthritis as a treatment option:
Documentation requirements for coverage include:
- Ambulatory status of the beneficiary
- Evidence of pain, mobility, or functional reduction due to tibiofemoral osteoarthritis
- Physical examination of affected knee(s)
- An imaging report (x-ray, CT scan, MRI) showing arthritic changes consistent with medial or lateral compartment tibiofemoral OA
- Beneficiary’s willingness to use the knee orthosis
Billing and compliance updates will require adjustments to prescribing and billing workflows, including the adoption of new ICD-10 codes and revised coverage criteria. CMS encourages providers to review the new policy guidelines to ensure compliance and optimize patient care.
More information can be found on cms.gov or downloading the guide below.
