2025 HCPCS code L0626
(Active) Effective Date: N/A Revision Date: N/A Orthotics - Lumbar Orthotics Orthotic Procedures and services Feed
Supply of a lumbar orthosis with sagittal control, rigid posterior panel, extending from L1 to below L5, providing intracavitary pressure to reduce intervertebral disc load.It's a prefabricated item customized to fit the patient.
Modifiers may apply depending on the circumstances of service.Consult the HCPCS modifier guidelines for applicable modifiers.
Medical necessity for L0626 is established by the presence of a clinical condition requiring lumbar spine support and stabilization, documented in the patient's medical record. This could include conditions such as degenerative disc disease, spondylolisthesis, post-surgical stabilization, or other conditions causing significant low back pain and functional limitations.
The clinical responsibility lies with the physician who orders and oversees the fitting and use of the lumbar orthosis.This includes assessment of the patient's condition, determination of medical necessity, and monitoring the effectiveness of the orthosis.
In simple words: This code covers the cost of a custom-fitted lower back brace.The brace is made to support your back, limit movement, and reduce pressure on your spinal discs. It's initially pre-made, but a specialist adjusts it to fit you perfectly.
This HCPCS code, L0626, represents the supply of a lumbar orthosis (LO) designed for sagittal control.The orthosis features a rigid posterior panel extending from the L1 vertebra to below the L5 vertebra. Its design produces intracavitary pressure, thereby reducing the load on the intervertebral discs. The orthosis includes straps and closures; it may also include padding, stays, and shoulder straps. A pendulous abdomen design might be incorporated. Importantly, this code applies to prefabricated items that have been modified (trimmed, bent, molded, assembled, or customized) by a qualified professional to precisely fit a specific patient.
Example 1: A patient presents with chronic lower back pain due to degenerative disc disease.The physician orders a custom-fitted L0626 lumbar orthosis to provide support, reduce pain, and improve functional mobility., A patient recovering from a lumbar spine surgery requires a brace to stabilize the spine and limit movement during the healing process. An L0626 brace is custom fitted to meet their specific needs., A patient with spondylolisthesis (a condition where one vertebra slips forward over another) benefits from the support and stabilization provided by a custom-fitted L0626 orthosis to alleviate pain and improve posture.
* Physician's order specifying the need for a lumbar orthosis.* Detailed clinical notes documenting the patient's diagnosis, symptoms, and functional limitations.* Measurements and fitting details obtained by the orthotist, demonstrating the customization of the prefabricated item.* Documentation of the patient's tolerance and response to the orthosis.
** This code should only be used when the prefabricated lumbar orthosis has been significantly altered to fit the individual patient.Minor adjustments do not warrant this code.
- Payment Status: Active
- Modifier TC rule: Not applicable to this code.
- Specialties:Orthopedics, Neurosurgery, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center