HR4475

The Medicare Orthotics and Prosthetics Patient-Centered Care Act (HR4475) was introduced July 17, 2025, with 30 cosponsors and a bipartisan cast (Rep. Thompson R-PA, Rep. Thompson D-CA, Rep. Bilirakis R-FL, Rep. Dingell D-MI). The bill is in the earliest legislative stage: referred to both Energy & Commerce and Ways & Means committees. A companion bill (S2329) exists in the Senate, which modestly increases passage probability but the 119th Congress is still in its first session and committee markups have not yet occurred. There are zero dollars authorized or appropriated by this bill — it is entirely regulatory, not a spending vehicle. The mechanism: Section 2(a) amends the Social Security Act to prohibit Medicare Part B payment for any orthotic or prosthetic item delivered via 'drop shipment' where the patient did not receive in-person fitting and training from a qualified practitioner. Section 2(b) expands the list of practitioners exempt from competitive acquisition to include physical therapists, occupational therapists, orthotists, and prosthetists. This directly benefits established clinic-based providers who already operate with in-person fitting workflows, and directly harms mail-order / e-commerce distributors who rely on drop-ship logistics for market share. The money trail is a margin shift, not a revenue injection: competitive bidding exemptions mean less price compression; drop-ship bans remove the lowest-cost supply channel, raising average reimbursement per unit for covered devices. Companies like ZBH and STRR that manufacture or distribute through the clinic channel capture this margin tailwind.