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

This section amends Medicare payment rules for orthotics and prosthetics (i.e., covered durable medical equipment under Part B) as follows: (1) prohibits payment under 42 U.S.C. 1395m(h)(1) for orthotics and prosthetics (excluding supplies), identified by HCPCS codes not subject to competitive acquisition, furnished via drop shipment—defined as direct shipment to a beneficiary without training on fitting, adjustment, care, and use from a qualified practitioner—on or after the first day of the first year beginning after enactment; (2) expands exemptions from the durable medical equipment competitive acquisition program under 42 U.S.C. 1395w-3(a)(7)(A)(i) to include items furnished incident to services by physical therapists, occupational therapists, orthotists, or prosthetists (in addition to physicians); (3) expands the replacement provision under 42 U.S.C. 1395m(h)(1)(G) to expressly cover custom-fitted orthotics and custom-fabricated orthotics (previously limited to prosthetic devices); and (4) directs the Secretary of Health and Human Services to promulgate final implementing regulations not later than one year after enactment.