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Over the past decade, orthopedic practices have added ancillary services, such as MRI and PT, that boost revenue to offset rising costs. Still, most practices have yet to fully develop DME and orthotic provision as a distinct ancillary division. This article explains the common models currently in use for DME provision and details the benefits orthopedic practices can realize by establishing a practice-operated DME ancillary service. In addition to a full discussion of the primary elements and challenges involved in establishing a DME/orthotic division, this article offers specific examples that demonstrate how such a division can benefit both the practice and the patient.