Medicare AdvantageCoverageMedium impact
MA05.013j, Knee Orthoses
Independence Blue Cross·Orthopedics, PM&R (Physical Medicine & Rehab), Sports Medicine +2 more·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for knee orthoses coverage, effective July 1, 2025. This policy change affects the requirements that must be met for knee braces and supports to be covered under MA plans.
Action Required
By July 1, 2025: Billing team must review and update documentation requirements for knee orthoses claims under Medicare Advantage plans. Verify that all knee brace prescriptions meet the new medical necessity criteria before submitting claims. Contact Medicare Advantage plans for specific documentation templates if needed to ensure compliance with updated coverage requirements.