Medicare AdvantageCoverageMedium impact
MA05.013k, Knee Orthoses
Independence Blue Cross·Orthopedics, PM&R (Physical Medicine & Rehab), Sports Medicine +1 more·Medical Policy
Effective date
Jan 25, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for knee orthoses coverage, effective January 25, 2026. This change will impact how knee brace and orthotic device claims are reviewed and approved for Medicare Advantage patients.
Action Required
Before January 25, 2026: Billing team must review and update documentation requirements for knee orthoses claims to meet new medical necessity criteria. Contact Medicare Advantage plans to obtain specific documentation guidelines. Providers should ensure medical records clearly document the medical necessity for knee orthoses to prevent claim denials.