Knee Orthoses - DME.MU.200.A

Prefabricated and custom-fabricated knee orthoses (specified HCPCS codes) are covered when medically necessary—covering jointed braces, immobilizers, locking/rigid braces, heavy‑duty joints (>300 lb), certain additions and knee‑extension assist mechanisms—while prophylactic braces and inflatable-air‑bladder prefabricated braces are excluded. Key requirements: clear documentation that the patient is ambulatory/pre‑ambulatory with knee weakness or structural abnormality requiring stabilization and expected functional improvement (locking/rigid braces require a non‑fixed contracture with ≥10° passive ROM), custom fabrication is allowed only if a prefabricated brace cannot be fitted or the condition is long‑standing/permanent (>6 months) or involves deformity/short‑or‑tall stature, additions must be provided with and medically necessary for the base orthosis, CAD/CAM and fitting are included in the orthosis allowance, and replacements require recent provider review plus growth/change, loss/theft, or irreparable/out‑of‑warranty brace.