2025 HCPCS code L0632

Supply of a custom-fabricated lumbosacral orthosis (LSO) with sagittal control, rigid anterior and posterior panels.

Follow CMS guidelines for orthotic coding and documentation requirements. Ensure that documentation supports medical necessity and the need for a custom-fabricated device.Detailed measurements and fabrication notes are crucial.

Modifiers may be applicable depending on the circumstances of service.Consult the HCPCS modifier guidelines for appropriate modifier usage. For example, modifiers related to rental or purchase options might apply.

Medical necessity for an L0632 is established by a physician's diagnosis of a condition requiring this type of custom-fabricated support.Documentation must justify the need for a custom-fabricated orthosis rather than a pre-fabricated one. The functional limitations imposed by the patient's condition must necessitate the custom fabrication to achieve the required level of support and pain relief.

The clinical responsibility rests with the physician who orders the orthosis and the orthotist who fabricates and fits it. The physician diagnoses the condition necessitating the orthosis, determines the type of orthosis needed, and orders it. The orthotist takes measurements, fabricates the orthosis, and ensures proper fit and function.

IMPORTANT L0630 and L0631 represent similar lumbosacral orthoses but may differ in fabrication or design specifications.Refer to the detailed descriptions for each code to determine the most appropriate selection.

In simple words: This code covers the cost of a custom-made brace for the lower back.The brace is designed to support the lower back and limit excessive movement, helping to relieve back pain.

This HCPCS code represents the supply of a custom-fabricated lumbosacral orthosis (LSO).This is a rigid LSO with anterior and posterior panels designed for sagittal plane movement control. The posterior panel extends from the sacrococcygeal junction to below the T9 vertebra. The orthosis provides compression and support to the lower back, limiting excessive lumbosacral spine movement. It may include additional features such as padding, shoulder straps, and a pendulous abdomen design.This device is individually manufactured for a specific patient based on their unique measurements and needs.

Example 1: A patient presents with chronic lower back pain following a lumbar fracture. The physician orders a custom-fabricated L0632 LSO to provide support and pain relief during healing., A patient undergoes spinal fusion surgery.Post-operatively, the surgeon orders an L0632 to stabilize the spine and aid in recovery. The orthotist ensures it's appropriately fitted to the patient's unique anatomy., A patient with degenerative disc disease experiences significant lower back pain and instability. The physician prescribes an L0632 orthosis to provide support and reduce pain by limiting excessive spinal movement. Regular follow-up appointments are scheduled to assess the effectiveness of the orthosis and to make any necessary adjustments.

Detailed documentation is necessary, including the physician's order specifying the need for a custom-fabricated LSO, the orthotist's notes on measurements, fabrication techniques, and fitting, and patient's clinical presentation and response to treatment.

** This code is specific to custom-fabricated LSOs.Ensure proper documentation to support medical necessity and the need for custom fabrication.Incorrect coding can lead to denied claims.Consult with an experienced medical biller/coder for clarification if needed.

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