Protect Patient Outcomes in Orthotic Bracing
Remote Item Delivery (RID) may shift how some orthotic braces are delivered, but many “off‑the‑shelf” (OTS) braces still benefit from in-person supplier fitting and patient education to be used effectively.
What is RID and Why It Affects Orthotic Care
What Is Remote Item Delivery (RID)?
Remote Item Delivery (RID) is a CMS approach within the DMEPOS Competitive Bidding Program that allows certain Medicare‑covered items to be delivered by mail from centralized suppliers rather than furnished in person by a local provider.
How CMS Intends to Use RID for Orthopedic Braces
Under RID, CMS would award a limited number of national competitive bidding contracts to suppliers authorized to furnish eligible OTS orthopedic braces through remote fulfillment.
How RID Affects Orthotic Care
Shift away from in-person care pathways
Brace delivery moves from local DMEPOS providers toward centralized distribution, where in‑person selection, fitting, adjustment, and patient education may no longer be in the standard care pathway.
Reclassification of off-the-self (OTS) braces
Many OTS orthopedic braces are treated as self‑adjustable over-the-counter (OTC) items rather than products supported by in-person clinical services.
Greater supply centralization
Distribution is consolidated among a limited number of national competitive bidding contract winners.
Together, these changes reflect a policy shift away from supplier supported orthotic care and toward remote, price‑driven distribution models.
"Off-the-Shelf" Does Not Mean "Self-Fitting."
“Off-the-shelf” orthotics are not simple retail items. Intended therapeutic benefit often requires:
Trained fitting
Assessment of mobility and limitations
Patient education
For many orthopedic braces, fit is not merely a delivery step. When key elements such as alignment, strap tension, hinge positioning, or range of motion settings are incorrect, patients may experience:
Discomfort
Reduced stability
Unintended biomechanical effects
Poor adherence or inconsistent use
Clinical Reality: Medicare, PDAC, and DME policy interpretations of “minimal self‑adjustment” can still involve meaningful modifications that exceed what many beneficiaries can reliably perform without trained in-person support.
In-Person Fit and Education can Improve Outcomes
Although slings are often perceived as simple devices, they are often supplied with careful fitting and patient education, and may involve follow‑up to ensure proper use1,2. Even minor fit issues can affect comfort and functional support. Research also indicates that patients with limited understanding of their orthotic requirements may experience higher rates of postoperative complications, including a reported 9× increase in retear risk in patients with poor understanding of sling use in one study3.
CORRECT
INCORRECT
Examples: OTS Orthoses That Commonly Require In‑Person Fitting and Configuration
Many of the OTS orthotic braces proposed for RID benefit from precise clinical measurement, hinge alignment, and adjustment to the patient’s anatomy to provide stability, safety, and therapeutic benefit.
Knee Orthoses
L1812 / L1833 / L1851 / L1852 / +
- Set flexion/extension stops
- Ensure proper joint alignment
- Configure varus/valgus stabilization and tibiofemoral control
- Reduce distal migration and rotational slippage through fit and contour adjustments
SLO / LO / LSO Spinal Orthoses
LO641 / L0648 / L0650 / L0651 / +
- Lordosis control tension
- Rotational control positioning
- ensure adequate lumbar coverage via height adjustments
- Fit & contour adjustments
TLSO Spinal Orthoses
L0450 / L0455 / L0457 / L0467 / L0469
- Kyphosis and lordosis control tension
- Rotational control positioning
- Ensure adequate lumbar and thoracic coverage via height adjustments
- Fit & contour adjustments
Shoulder Orthoses
L3650 / L3660 / L3670 / +
- Set prescribed immobilization angles (scapular retraction, abduction, extension/flexion, elbow flexion)
- Confirm wrist/hand support positioning
- Perform fit & contour adjustments
Elbow Orthoses
L3710 / L3761 / L3762
- Setting flexion/extension stops
- Proper joint alignment
- Ensuring symmetric joint alignment
- Reduce rotational slippage
- Fit & contour adjustments
Wrist/Hand/Digit Orthoses
L3809 / L3908 / L3916 / L3924 / +
- Contour volar/dorsal stays for prescribed immobilization
- Modify thumb positioning as needed
- Apply padding for alignment control and comfort
- Perform fit & contour adjustments
A Brace is Most Effective When It Fits The Patient
Even within the same HCPCS code, patient needs vary significantly. Appropriate brace selection and setup depends on goals, history, anatomy, and functional limitations, factors that are routinely clarified during fitting and education.
Misfit isn’t just an inconvenience, it may delay care
When an orthosis arrives in the wrong size or does not meet a patient’s clinical needs, the result may be delay in care, prolonged pain, or reduced functional recovery.
Factors a Drop‑Ship Model Cannot Evaluate
Patient Goals
- When does your knee hurt the most?
- What activities do you want to do with less pain?
- How active are you?
- Is comfort or activity more important?
Past Bracing
-
Have you worn a knee brace before?
-
What did you like?
-
What didn’t work?
Anatomy
-
Is the thigh or calf larger?
-
Any skin sensitivity, or circulation issues?
-
Limited hand strength or dexterity?
-
Can you bend easily to put on a brace?
A Clinically Appropriate Path Forward
We share CMS’s commitment to program integrity, and we believe there are more targeted ways to reduce fraud and improper utilization while supporting patient safety without removing critical clinical touchpoints for orthotic care.
A risk‑based approach can protect patients while supporting CMS goals:
Exclude OTS orthotics that require skilled fitting and education from RID until real‑world patient impact is evaluated.
Create an “OTS+” category for braces that are technically OTS but clinically dependent on professional fitting and instruction, excluding them from the RID bid.
Strengthen prior authorization (PA) as the integrity lever including supplier incentives such as “gold card” exemptions for proven compliant suppliers, rather than relying on remote distribution to control risk.
Delay implementation until CMS completes a comprehensive access and impact analysis, including rural beneficiary effects, marketplace stability, and clinical outcomes.
Share Your Clinical Perspective (2 minutes)
Share Your Clinical Perspective
(2 minutes)
If you believe many OTS braces benefit from in-person fitting and education, you can share a brief clinical perspective with your elected representative.
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References
- Hanchard N, Goodchild L, Thompson J, O’Brien T, Davison D. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of shoulder impingement syndrome. Physiotherapy. 2012.
- van der Meijden OA, et al. Patient compliance after shoulder immobilization. Journal of Shoulder and Elbow Surgery. 2014.
- Livesey MG, Weir TB, Addona JL, Curto RA, Apte A, Hughes M, Enobun B, Henn RF 3rd, Hasan SA, Gilotra MN. The Effect of Patients' Understanding of Sling Necessity and Home Assistance on Sling Wear After Shoulder Surgery. Am J Sports Med. 2023 Jan;51(1):179-186. doi: 10.1177/03635465221131984. Epub 2022 Nov 9. PMID: 36349935.
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The information provided on this site is intended to inform and empower patients, caregivers, and advocates to engage with their elected representatives. Enovis stands to be directly affected—financially and operationally—by the outcomes of the legislative and regulatory actions referenced on this site. In other words, we have a clear stake in the issues being addressed.
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