2025 HCPCS code L0633
(Active) Effective Date: N/A Revision Date: N/A Orthotic - Lumbar-sacral Orthotics Orthotic Procedures and services Feed
Supply of a prefabricated lumbosacral orthosis with expert modification for custom fit.
Modifiers may be applicable depending on the circumstances of service. Consult the most recent CMS guidelines for applicable modifiers.
Medical necessity for an LSO is determined by the physician based on the patient's diagnosis, clinical presentation, and response to conservative treatments. Documentation must support the need for the orthosis and show that it's necessary for the patient's treatment.
A physician or other qualified healthcare professional assesses the patient's condition and determines the medical necessity for an LSO.An orthotist or other qualified professional fits and adjusts the orthosis to ensure proper fit and function. The clinical responsibility also includes monitoring the patient's response to the orthosis and making necessary adjustments.
In simple words: This code covers the cost of a custom-fitted back brace for the lower back. The brace is pre-made but adjusted by a specialist to fit the patient perfectly. It helps support the back and limit movement, often used for back pain or after back surgery.
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 movement control in sagittal and coronal planes. The orthosis is modified by a specialist to achieve a custom fit for the patient.It may include additional features like extra padding, shoulder straps, and a pendulous abdomen design.
Example 1: A patient presents with chronic lower back pain. After evaluation, the physician orders a custom-fitted lumbosacral orthosis (LSO) to provide support and pain relief. Code L0633 is used to bill for the supply of the brace., A patient undergoes lumbar spine surgery. Post-operatively, the surgeon recommends an LSO to help stabilize the spine and reduce pain during healing. Code L0633 is used for the supply and fitting of the orthosis., A patient experiences a lumbosacral fracture. To prevent further injury and promote healing, an LSO is prescribed. Code L0633 is used to bill for the brace.
Physician's order specifying the type of orthosis, patient's medical history, physical examination findings documenting the need for an LSO, details of the custom fitting process, and any follow-up evaluations. Documentation of the materials and components used in the device may also be required.
** This code covers the supply and custom fitting of a prefabricated lumbosacral orthosis.The level of customization is a key factor in determining the appropriate code.
- Payment Status: Active
- Specialties:Orthopedics, Physical Medicine and Rehabilitation, Neurosurgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center