2025 HCPCS code L0630
(Active) Effective Date: N/A Revision Date: N/A Orthotics - Lumbar-sacral Orthotics Orthotic Procedures and services Feed
Supply of a prefabricated lumbosacral orthosis, customized to fit a specific patient.
Modifiers may apply depending on the circumstances of service delivery (e.g.,-KX for meeting specific medical policy requirements, -CG for policy criteria applied, -AV if furnished with prosthetic device). Consult payer-specific guidelines for additional modifier requirements.
Medical necessity is established by documenting a diagnosis requiring spinal support and immobilization, such as chronic back pain, spinal fracture, or post-surgical stabilization.The physician's order should specify the need for a custom-fitted LSO and justify the choice of L0630 over other bracing options.
A provider recommends this orthosis for spinal conditions such as chronic back pain, lumbosacral fracture, and postoperative stabilization.It reduces pain by supporting the joints and reducing muscle tension.The orthosis creates intracavitary abdominal pressure, increasing space between vertebrae and transferring load from intervertebral discs to soft tissues.
In simple words: This code covers the cost of a special back brace (lumbosacral orthosis) that's made to fit a patient's back perfectly. Although it starts as a pre-made brace, it is adjusted by a specialist to make it comfortable and supportive for the individual.
This HCPCS code represents the supply of a prefabricated lumbosacral orthosis (LSO), a brace designed to immobilize the lumbar and sacral spine.It features a rigid posterior panel and provides sagittal plane movement control. The orthosis extends from the sacrococcygeal junction to just below the ninth thoracic vertebra (T9).While prefabricated, it undergoes expert modification for a custom fit, including trimming, bending, molding, assembly, or other adjustments by a qualified professional.It may include additional features such as extra padding, shoulder straps, and/or a pendulous abdomen design with an extra strap.
Example 1: A patient with chronic lower back pain receives a custom-fitted L0630 brace to provide support and reduce pain during daily activities., Following a lumbar fracture, a patient is fitted with an L0630 brace to provide spinal stability and promote healing., Post-lumbar spine surgery, a patient uses an L0630 brace to stabilize the spine and prevent excessive movement during recovery.
Medical records must include documentation of the patient's spinal condition, the necessity for an LSO, specific measurements for custom fitting, and verification that the modifications were performed by a qualified professional.Pre- and post-fitting assessments should be documented.
** This code encompasses a range of modifications to a prefabricated brace; detailed documentation is crucial for accurate coding and reimbursement.
- Payment Status: Active
- Specialties:Orthopedics, Neurosurgery, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center