H.R. 4475: Medicare Orthotics and Prosthetics Patient-Centered Care Act
Sponsor
Glenn Thompson
Republican · PA-15
Bill Progress
Latest Action · Jul 17, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Medicare wouldn't pay for prosthetics shipped sight unseen
Why it matters
Medicare would stop paying for prosthetic limbs, braces, and similar custom devices when they're shipped directly to patients who haven't been fitted or trained on how to use them. The ban kicks in the first year after enactment, and HHS would have a year to write the rules. Sponsors say drop-shipped prosthetics fuel Medicare fraud and put patients at risk.
H.R. 4475 — the Medicare Orthotics and Prosthetics Patient-Centered Care Act — targets a specific Medicare practice: paying for prosthetic limbs, leg braces, and similar custom devices that arrive at a patient's door without any in-person fitting or instruction.
Under the bill, Medicare couldn't pay for those items when they're delivered by 'drop shipment.' The bill defines drop shipment narrowly: a device sent to a patient who hasn't been trained by a qualified practitioner on how to fit, care for, and use it. If training happened first, the shipment is still allowed.
The bill also adds four new types of providers to Medicare's competitive acquisition exemption list: physical therapists, occupational therapists, orthotists, and prosthetists. These are the clinicians who actually fit and adjust devices in person, and exempting them makes it easier for patients to get care through hands-on providers instead of mail-order suppliers.
A separate fix expands Medicare's replacement rules to specifically include custom-fitted and custom-fabricated orthotics. Under current law, patients with worn-out custom braces have a harder time getting them replaced.
The Secretary of Health and Human Services would have one year after enactment to issue final regulations. The real impact will depend on how HHS defines 'qualified practitioner' and what counts as adequate training — those rules decide which suppliers stay in the Medicare market and how strict the ban actually is.
H.R. 4475 Bill Summary
What H.R. 4475 actually does.
Medicare wouldn't pay for drop-shipped prosthetics or braces
Medicare couldn't pay for orthotics and prosthetics shipped directly to patients who haven't received hands-on training from a qualified practitioner. The ban kicks in the first year after the bill's enactment.
Drop shipment defined by what's missing
The bill defines 'drop shipment' as direct delivery of a device to a patient who hasn't been trained by a qualified practitioner on three specific things: fitting and adjustment, care, and proper use of the item.
Only certain items, no supplies
The ban covers orthotics and prosthetics identified by Medicare billing codes that aren't already in the competitive bidding program. Supplies for those items — like socks, liners, and pads — are explicitly excluded.
Therapists and orthotists added to exempt provider list
Physical therapists, occupational therapists, orthotists, and prosthetists would join the list of practitioners exempt from Medicare's competitive acquisition rules for these devices. That recognizes their role in directly fitting and educating patients.
Custom orthotic replacements get explicit coverage
Medicare's replacement rules would expand to clearly cover replacement of custom-fitted and custom-fabricated orthotic devices. Current law focuses on prosthetic devices and artificial limbs, leaving custom orthotic replacements in a grayer zone.
HHS has one year to write the rules
The Secretary of Health and Human Services must issue final implementing regulations within one year of the bill becoming law. Those rules will define 'qualified practitioner' and acceptable training standards.
Who benefits from H.R. 4475?
Medicare patients receiving prosthetics or orthotics
Patients getting new prosthetic limbs, leg braces, back braces, or similar custom devices would have stronger protection against receiving a device with no clinical fitting or instruction. Medicare wouldn't pay for the device unless training happened first.
Patients needing replacement custom braces
Medicare patients with worn-out custom-fitted or custom-fabricated orthotic devices would have a clearer path to a covered replacement, instead of relying on the current statute's narrower language.
Physical and occupational therapists
These two clinician groups join the competitive acquisition exemption, which could open a Medicare payment pathway for therapists who already fit and adjust devices as part of patient care.
Orthotists and prosthetists
Specialists who fit prosthetic limbs and custom braces are explicitly added to the exempt list, recognizing the in-person, hands-on work that distinguishes them from mail-order suppliers.
Who is affected by H.R. 4475?
Suppliers shipping orthotics and prosthetics directly to patients
Suppliers who deliver devices without first arranging clinical training would lose Medicare payment for those items. The change takes effect the first year after enactment.
Centers for Medicare & Medicaid Services and HHS
Federal regulators would need to write final rules within one year of enactment, including definitions for 'qualified practitioner' and what counts as adequate training, care, and fitting instruction.
Medicare contractors and claims processors
Contractors who process Medicare claims would need a way to verify whether a patient received the required training before approving payment for orthotic or prosthetic items.
Patients who currently order devices online
Medicare patients who buy braces or prosthetic items through online or mail-order channels would need to confirm a qualified practitioner provided fitting and training first, or Medicare wouldn't cover the device.
What Congress Is Saying
H.R. 4475 hasn't been debated on the floor yet.
This section updates when a legislator speaks about it on the floor or in committee.
HR4475 Legislative Journey
House: Committee Action
Jul 17, 2025
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
About the Sponsor
Glenn Thompson
Republican, Pennsylvania's 15th congressional district · 17 years in Congress
Committees: Agriculture, Education and Workforce
View full profile →
Cosponsors (29)
This bill has 29 cosponsors: 20 Democrats, 9 Republicans, reflecting bipartisan support. Cosponsors represent 20 states: Alabama, California, Colorado, and 17 more.
Mike Thompson
Democrat · CA
Gus Bilirakis
Republican · FL
Debbie Dingell
Democrat · MI
Raul Ruiz
Democrat · CA
Donald Davis
Democrat · NC
Daniel Meuser
Republican · PA
Michael Lawler
Republican · NY
Jason Crow
Democrat · CO
Julia Brownley
Democrat · CA
Josh Gottheimer
Democrat · NJ
Sharice Davids
Democrat · KS
Eleanor Norton
Democrat · DC
Committee Sponsors
Ways and Means Committee
5 of 45 committee members cosponsored
Energy and Commerce Committee
4 of 54 committee members cosponsored
51 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 4475 Quick Facts
- Committee
- Ways and Means
- Chamber
- House
- Policy
- Health
- Introduced
- Jul 17, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Jul 17, 2025
Official Sources
Official congressional bill page for the Medicare Orthotics and Prosthetics Patient-Centered Care Act.
The Medicare payment statute the bill amends — Section 1834(h) is where the new drop-shipment payment prohibition and expanded custom orthotic replacement rules would be inserted.
Official text of section 1847 of the Social Security Act, which governs Medicare competitive acquisition rules and the practitioner exemption list the bill expands to physical therapists, occupational therapists, orthotists, and prosthetists.
HHS Office of Inspector General 2024 audit documenting fraud, waste, and abuse in Medicare orthotic brace payments — the precise pattern the bill's drop-shipment ban is designed to stop.
CMS program page for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding system — the program from which the bill's affected items must be excluded and to which the new exempt practitioners are added.
CMS coverage and payment page for Medicare prosthetic and orthotic devices, including the custom-fitted and custom-fabricated items whose replacement rules the bill expands.
Official CMS page on the HCPCS Level II coding system the bill uses to identify which orthotic and prosthetic items are covered by the drop-shipment payment ban.
CMS resource hub of the statutes and regulations governing Medicare DMEPOS — relevant background for the implementing rules HHS must promulgate within one year of enactment.
H.R. 4475 Common Questions
What is 'drop shipment' under H.R. 4475, and why would Medicare stop paying for it?
Drop shipment means a prosthetic, brace, or similar device gets shipped directly to a Medicare patient who hasn't been trained by a qualified practitioner on fitting, care, and use. Sponsors say drop-shipped devices fuel Medicare fraud and risk patient harm, so the bill would block payment for them.
Can a Medicare patient still get a brace shipped to their home if they had training first?
Yes. The ban only blocks Medicare payment when the patient hasn't received training from a qualified practitioner on fitting, care, and use. If clinical training happened first, the shipment is still allowed and Medicare can still pay.
Does the ban apply to all Medicare orthotics and prosthetics?
No. It covers orthotics and prosthetics identified by Medicare billing codes that aren't already in the competitive bidding program. Supplies for those items — like socks, liners, or replacement pads — are explicitly excluded.
Which providers does H.R. 4475 exempt from Medicare competitive bidding?
Physical therapists, occupational therapists, orthotists, and prosthetists would join the existing exemption list. These are the practitioners who typically fit and adjust devices in person rather than ship them by mail.
Does H.R. 4475 expand replacement coverage for custom orthotics?
Yes. Medicare's replacement rules would explicitly cover replacement of custom-fitted and custom-fabricated orthotic devices. The current statute focuses on prosthetic devices and artificial limbs, leaving custom orthotic replacements in a grayer zone.
When would the drop-shipment ban take effect?
The payment ban would kick in on the first day of the first year beginning after enactment. The Secretary of Health and Human Services would also have one year from enactment to issue final regulations defining how the ban is enforced.
Does H.R. 4475 create a new penalty for suppliers who drop ship?
No separate civil or criminal penalty is added. The enforcement is built into Medicare payment itself — if a device is delivered by drop shipment as the bill defines it, Medicare can't pay the supplier for it.
Based on H.R. 4475 bill text
H.R. 4475 Bill Text
“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.”
Source: U.S. Government Publishing Office
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