Sponsors (32)
The bill prioritizes safer, practitioner-fitted orthotics/prosthetics and clearer Medicare payment rules to reduce improper claims, but it may delay access and raise costs for some beneficiaries (especially in rural areas) and increase administrative burdens for suppliers.
Medicare beneficiaries will more often receive custom-fitted orthotics and prosthetics fitted by trained practitioners rather than unassisted shipments, improving fit, function, and safety.
Taxpayers and the Medicare program gain clearer payment rules (and exclusion of certain items from competitive acquisition), which should reduce improper claims, program waste, and payment disputes.
Medicare beneficiaries may experience delayed access to needed orthotics/prosthetics or require additional appointments if suppliers must arrange practitioner fitting instead of shipping items directly.
Medicare beneficiaries in rural or underserved areas may face higher out-of-pocket costs or reduced access if local fitting services are unavailable and drop-shipments become non-covered.
Suppliers and durable medical equipment providers (and related hospitals/health systems) will likely incur increased administrative burden and compliance costs to track HCPCS applicability and implement the new rules.
Based on analysis of 2 sections of legislative text.
Prohibits Medicare payment for orthotics and prosthetics delivered by "drop shipment" (except supplies and competitive acquisition items) and requires CMS rules within 1 year.
Official title: To amend title XVIII of the Social Security Act to protect beneficiaries with limb loss and other orthopedic conditions by providing access to appropriate, safe, effective, patient-centered orthotic and prosthetic care, to reduce fraud, waste, and abuse with respect to orthotics and prosthetics, and for other purposes.
Introduced July 17, 2025 by Glenn Thompson · Last progress July 17, 2025
Prohibits Medicare payment for orthotics and prosthetics (excluding supplies) that are delivered to beneficiaries via “drop shipment” starting the first day of the first calendar year after the Act is enacted, while exempting items already paid through the competitive acquisition program. It defines “drop shipment” as direct delivery to a person who has not received practitioner training or education on fitting, adjustment, care, and use, requires the HHS Secretary to issue final implementing regulations within one year, and makes conforming textual changes to related Medicare payment statutes.