2025 HCPCS code L0634
(Active) Effective Date: N/A Revision Date: N/A Orthotics - Lumbar-sacral Orthotics Orthotic Procedures and services Feed
Supply of a custom-fabricated lumbosacral orthosis (LSO) with rigid posterior panels for sagittal and coronal plane movement control.
Modifiers may be applicable depending on the circumstances of service.For example, modifiers related to the type of service, place of service, or multiple procedures may apply.Always consult current coding guidelines and payer specific rules.
Medical necessity for an L0634 orthosis is established by the presence of a condition requiring spinal support, such as chronic low back pain, spinal fracture, or post-surgical stabilization. Documentation must support the diagnosis and demonstrate the need for this specific type of orthosis as a medically appropriate and necessary intervention.
A physician (e.g., orthopedist, physiatrist) or other qualified healthcare provider orders and oversees the use of the LSO.The provider assesses the patient's condition, determines the medical necessity of the orthosis, and may participate in the fitting and adjustment process.
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 movement to help relieve pain and stabilize the spine. It's made specifically to fit the patient.
This HCPCS code represents the supply of a custom-fabricated lumbosacral orthosis (LSO), a brace designed to immobilize the lumbar and sacral spine.It features rigid posterior panels extending from the sacrococcygeal junction to below the T9 vertebra, and a rigid lateral frame for lateral support. This design restricts flexion in the sagittal and coronal planes. The orthosis provides compression and support to the lower back, reducing excessive movement and pain by supporting joints and reducing muscle tension. It may include extra padding, shoulder straps, and a pendulous abdomen design with an extra strap.The orthosis is custom-made to the patient's individual specifications.
Example 1: A patient with a chronic low back pain condition receives a custom-fabricated L0634 orthosis to provide support and reduce pain during daily activities and prevent further injury., A patient recovering from a lumbar spine fracture is fitted with an L0634 orthosis to stabilize the spine and promote healing. The orthosis is used until the fracture is sufficiently healed., Post-surgery, a patient undergoes rehabilitation, and an L0634 orthosis is utilized to provide spinal support and minimize stress on the healing surgical site during the recovery period.This helps prevent re-injury.
* Physician's order specifying the need for a custom-fabricated lumbosacral orthosis.* Detailed clinical notes documenting the patient's diagnosis and the rationale for the LSO.* Measurements and other specifications used in the fabrication of the orthosis.* Documentation of the fitting and adjustment process and patient education provided.* Progress notes documenting the patient's response to the orthosis, effectiveness in reducing pain or improving function.
** Ensure that the orthosis is custom-fabricated to meet the individual needs of the patient. Accurate documentation of the patient's condition and the specifications of the orthosis are crucial for appropriate billing.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code as it represents the supply of the orthosis itself.
- Fee Schedule : Historical fee schedule data for this code can vary based on payer and location. It's crucial to consult fee schedules from relevant payers for specific periods.
- Specialties:Orthopedics, Physical Medicine and Rehabilitation, Neurosurgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center