2025 HCPCS code L0640

Lumbosacral orthosis (LSO) with sagittal-coronal control, custom fabricated.

Adhere to all relevant HCPCS coding guidelines and payer-specific policies for orthotic devices.Ensure documentation supports the medical necessity and proper coding.

Modifiers may apply depending on the circumstances of service.Consult the HCPCS modifier guidelines for specific situations.

Medical necessity is established through the physician's documentation supporting the need for this specific type of custom-made LSO.Conditions such as chronic back pain, lumbosacral fractures, or post-surgical spinal stabilization may justify the medical necessity.

The clinical responsibility lies with the physician who orders the orthosis and the orthotist who fabricates and fits it. The physician determines the medical necessity, while the orthotist ensures proper fit and function.

IMPORTANT For similar devices with different control features, consider codes L0633-L0639 and L0649-L0650 (sagittal-coronal control) or L0626-L0627 and L0641-L0648 (sagittal control).

In simple words: This code covers a custom-made brace for the lower back (lumbosacral orthosis).It's designed to support the lower back and limit movement, helping to ease pain.

This HCPCS code, L0640, represents the supply of a custom-fabricated lumbosacral orthosis (LSO).The LSO features sagittal-coronal control, rigid shell(s)/panel(s), posterior extension from the sacrococcygeal junction to the T-9 vertebra, anterior extension from the symphysis pubis to the xiphoid process.It uses intracavitary pressure to reduce the load on intervertebral discs and incorporates overlapping rigid material and stabilizing closures (straps and closures) for overall strength.A soft interface and pendulous abdomen design may be included.

Example 1: A patient with a chronic low back pain condition unresponsive to conservative treatments may benefit from a custom-fabricated LSO to provide support and pain relief., Following a lumbosacral fracture, this type of orthosis can help stabilize the spine and promote healing., Post-surgery, an LSO can provide necessary spinal stabilization during recovery, promoting proper healing and reducing pain.

Detailed physician's order specifying the need for a custom-fabricated LSO, including the patient's specific measurements and clinical presentation.Orthotist's documentation should demonstrate the custom fabrication process and the patient's assessment of the proper fit.

** This code is specific to custom-fabricated LSOs.Prefabricated orthoses with similar functionality may be coded differently.Always ensure accurate documentation to support the medical necessity and coding choices.

  • Payment Status: Active
  • Specialties:Orthopedics, Neurosurgery, Physical Medicine and Rehabilitation
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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