2025 HCPCS code L0631

Supply of a prefabricated lumbosacral orthosis, customized for a specific patient.

Follow current HCPCS coding guidelines and payer-specific requirements when billing for L0631. Ensure all documentation requirements are met.

Modifiers may apply depending on the circumstances of service. Consult the HCPCS modifier guidelines for appropriate use.

Medical necessity for an L0631 brace is established when a patient has a diagnosed spinal condition requiring support, immobilization, or pain relief. Documentation must support the need for this specific type of orthosis and demonstrate that less invasive treatments have been tried or are not appropriate.

A physician or other qualified healthcare professional assesses the patient's condition and determines the medical necessity for an LSO. They may order the brace and oversee its proper fitting and use.An orthotist or other qualified professional customizes the prefabricated brace to fit the patient's specific needs.

IMPORTANT For other sagittal control lumbosacral orthoses, see codes L0630 to L0632.

In simple words: This code covers the cost of a custom-fitted back brace designed to support the lower back and help relieve pain.The brace is made from a pre-fabricated design but is adjusted by a specialist to fit the patient perfectly.

This HCPCS code represents the supply of a prefabricated lumbosacral orthosis (LSO), a sagittal control brace with rigid anterior and posterior panels.The posterior panel extends from the sacrococcygeal junction to the T9 vertebra. It's designed to produce intracavitary pressure, reducing the load on intervertebral discs. The orthosis includes straps and closures; it may also include padding, shoulder straps, and a pendulous abdomen design.A qualified individual modifies the prefabricated item to custom fit a specific patient.

Example 1: A patient with chronic lower back pain due to degenerative disc disease receives a custom-fitted L0631 brace to provide support and pain relief. The physician orders the brace, and an orthotist fits and adjusts the brace to ensure proper alignment and comfort., A patient recovering from a lumbar spine fracture uses an L0631 brace to stabilize the spine during the healing process.The orthosis provides support, prevents excessive movement, and promotes healing.The patient's physical therapist monitors their progress and ensures the proper use of the brace., A patient undergoes lumbar spine surgery.Post-operatively, the surgeon orders an L0631 brace to provide support and help prevent further injury during the recovery period. The brace is customized to fit the patient and instructions on use are provided.

Physician's order specifying the need for an LSO, including the diagnosis, patient's specific needs, and justification for medical necessity.Detailed documentation of the fitting and customization process by the orthotist, including measurements and adjustments made.Progress notes showing the impact of the brace on the patient's condition.

** The pricing for this code may be subject to floors and ceilings, depending on payer-specific policies. Always refer to the most up-to-date HCPCS codebook and local coverage determinations.

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