2025 HCPCS code L0623

Supply of a prefabricated sacroiliac orthosis with a rigid or semi-rigid panel.

Consult the most up-to-date HCPCS coding guidelines for proper use and documentation requirements for this code.

Modifiers may be applicable depending on the specific circumstances of service, such as those related to the type of service rendered (e.g., bilateral), place of service, or any other factors. Refer to relevant guidelines.

Medical necessity for a sacroiliac orthosis (L0623) is established by the presence of a condition requiring support and stabilization of the sacroiliac joint, such as sacroiliac joint dysfunction, pain, or instability related to a medical condition or surgical procedure.Documentation should support the clinical rationale for its use and the expected benefit.

The clinical responsibility involves assessing the patient's need for sacroiliac support, determining the appropriate type of orthosis (prefabricated vs. custom), fitting the orthosis, and educating the patient on its proper use and care.

IMPORTANT L0624 represents a custom-fabricated sacroiliac orthosis, in contrast to the prefabricated nature of L0623.

In simple words: This code covers the cost of a ready-made brace that supports the lower back and pelvis.It's used to help with pain and stability in that area.

This HCPCS code represents the supply of a prefabricated sacroiliac orthosis.This brace comes in various designs to immobilize the sacroiliac joints and provide support to the pelvis and sacrum. It features a rigid or semi-rigid panel over the sacrum and abdomen.The orthosis is prefabricated, meaning it's manufactured in standard sizes rather than custom-made for a specific patient.

Example 1: A patient presents with chronic lower back pain diagnosed as sacroiliac joint dysfunction.The physician orders a prefabricated sacroiliac orthosis (L0623) to provide support and pain relief. The orthosis is dispensed, and the patient is educated on its use., A patient recovering from a minimally invasive sacroiliac joint fusion surgery requires temporary support.A prefabricated sacroiliac orthosis (L0623) is provided to stabilize the joint and aid in pain management during the post-operative recovery phase., A patient with osteoarthritis affecting the sacroiliac joints experiences significant pain and instability. A prefabricated sacroiliac belt (L0623) is prescribed to provide support, reduce pain, and improve function. The patient's progress is monitored during follow-up appointments.

Physician's order specifying the need for a sacroiliac orthosis, including the type (prefabricated), patient's diagnosis, and clinical justification for medical necessity.Documentation of the fitting process, patient education, and any relevant measurements or assessments.

** Always verify the code's accuracy and appropriateness based on the specific clinical scenario and current payer guidelines.Consider consulting with a qualified coding specialist to ensure compliance.

  • Payment Status: Active
  • Modifier TC rule: A technical component (TC) modifier may not be applicable to this supply code, as it represents a durable medical equipment (DME) item.
  • Fee Schedule : Fee schedule data for this code is not provided. Consult relevant fee schedules from payers and other sources for information on historical and current reimbursement.
  • Specialties:Orthopedics, physiatry, pain management
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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