H.R. 4475: Medicare Orthotics and Prosthetics Patient-Centered Care Act

HR 4475, introduced on 2025-07-17 with 29 cosponsors, focuses on how Medicare pays for orthotics and prosthetics and who can provide them. Its core idea is simple: Medicare should not pay for certain devices when they are just shipped to a patient's door without proper hands-on training and education. The bill targets orthotics and prosthetics identified by HCPCS codes for which payment is not made under section 1847, and it specifically excludes supplies for those items from this rule.

The biggest change is a ban on Medicare payment for items furnished by "drop shipment." The bill defines "drop shipment" as the direct shipment of an item to an individual who has not received training or education from a qualified practitioner on the fitting and adjustment, care, and use of that item. That payment ban would take effect on or after the first day of the first year beginning after enactment, giving Medicare and providers some lead time to adjust.

The bill also broadens which practitioners are exempt from Medicare's competitive acquisition rules. It adds 4 categories to the exempt list in section 1847(a)(7)(A)(i): physical therapists, occupational therapists, orthotists, and prosthetists. That could make it easier for Medicare patients to receive care through practitioners who do direct evaluation, fitting, and follow-up rather than through a narrower supplier channel.

Another practical change is on replacements. The bill expands Medicare's replacement provision in section 1834(h)(1)(G) to include replacement of custom-fitted orthotics and replacement of custom-fabricated orthotics described in subparagraph (F)(ii). To put the policy into operation, the Secretary of Health and Human Services must issue final regulations not later than 1 year after enactment, which means the real impact will depend heavily on how HHS writes and enforces those rules.