Medicare tightens orthotics rules: no more drop-shipped devices without fitting

What it does

This bill prohibits Medicare from paying for orthotics and prosthetics delivered via 'drop shipment' (direct shipment to patients without prior fitting training from a qualified practitioner), and expands the list of practitioners who can prescribe these devices to include physical therapists, occupational therapists, orthotists, and prosthetists—not just physicians. It also ensures Medicare covers replacement of custom-fitted and custom-fabricated orthotics. The net effect is to strengthen patient safety and access by requiring proper fitting and expanding who can authorize these devices.

Why we flagged it

The bill's core function is to protect Medicare beneficiaries from unsafe drop-shipment practices and expand access to qualified practitioners. It is a regulatory safeguard, not a subsidy or carve-out.

What the text implies

• Expansion of practitioner authority (physical therapists, occupational therapists, orthotists, prosthetists) may reduce physician gatekeeping and increase direct-to-patient prescribing, potentially shifting referral patterns and revenue flows within the orthotic/prosthetic supply chain.
• Drop-shipment ban may increase costs for Medicare if compliant suppliers charge more for direct-fit services, or may reduce market competition if smaller suppliers cannot absorb fitting-training overhead.

The full analysis lists 3 implications of this text.

Who stands to gain

Qualified orthotists and prosthetists (expanded prescribing authority); Physical therapists and occupational therapists (new prescribing authority); Orthotic and prosthetic manufacturers with in-house fitting capabilities