2025 HCPCS code L0639
(Active) Effective Date: N/A Revision Date: N/A Orthotics - Lumbar-sacral Orthotics Orthotic Procedures and services Feed
Supply of a lumbosacral orthosis (LSO) with sagittal-coronal control, featuring rigid shells/panels, customized to fit a specific patient.
Modifiers may apply depending on the circumstances of service. For example, modifiers could indicate multiple orthoses, bilateral fitting, or other relevant adjustments.
Medical necessity is established by demonstrating a clear clinical need for an LSO to treat a specific spinal condition, such as chronic pain, spinal instability, or post-surgical stabilization. The documentation must support the choice of L0639 over other less restrictive or more costly options.
The clinical responsibility involves assessment of the patient's spinal condition, determining the need for an LSO, selecting the appropriate type of orthosis (L0639), ensuring proper fitting and customization, and providing patient education on use and care.
In simple words: This code covers the cost of a custom-fitted back brace that supports the lower back and helps limit movement.The brace is made from a prefabricated model but is modified by a specialist to fit the patient perfectly.
This HCPCS code, L0639, represents the supply of a lumbosacral orthosis (LSO).This orthosis provides sagittal and coronal plane movement restriction. It has rigid anterior and posterior shells/panels. The posterior portion extends from the sacrococcygeal junction to the T9 vertebra, while the anterior extends from the symphysis pubis to the xiphoid process.Intracavitary pressure is produced to reduce the load on the intervertebral discs.The overall strength comes from overlapping rigid material and stabilizing closures, including straps and closures. A soft interface may be included, and a pendulous abdomen design is possible. The orthosis is prefabricated but is trimmed, bent, molded, assembled, or otherwise customized to fit the individual patient by a qualified professional.
Example 1: A patient presents with chronic lower back pain due to degenerative disc disease. After a comprehensive evaluation, the physician orders a custom-fitted L0639 orthosis to provide support and pain relief., Following lumbar spine surgery, a patient requires an LSO for postoperative stabilization.An L0639 brace is custom-fitted to ensure optimal support and prevent excessive movement., A patient with a lumbosacral fracture needs an orthosis to immobilize the spine. An L0639 orthosis is chosen due to its sagittal-coronal control and customizable fit to accommodate the fracture.
* Physician's order specifying the need for a lumbosacral orthosis and the rationale for choosing L0639.* Detailed clinical examination findings documenting the patient's spinal condition and the need for immobilization.* Measurements and specifications of the custom-fitted orthosis to justify the selection of L0639.* Documentation of the fitting process and any modifications made to the prefabricated orthosis.* Patient education regarding the use and care of the orthosis.
** The L0639 code encompasses various design features.Ensure the documentation accurately reflects the specific characteristics of the supplied orthosis.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may not be applicable to L0639 as it represents the supply of the orthosis itself, not a distinct service.
- Specialties:Orthopedics, Neurosurgery, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center