HCPCS Code L0626

Official Description

Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Short Descr	Lo sag rig pnl stays pre cst
Coverage	Carrier Priced
Pricing Indicator(s)	38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI	A – Not applicable, as HCPCS priced under one methodology
BETOS	D1F – Prosthetic/Orthotic devices
TOS Code(s)	P – Lump sum purchase of DME, prosthetics, orthotics
Added Date	1/1/2006
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	0
MUE	1
OTS Orthotic	Yes
CCS Clinical Classification	243 - DME and supplies

KX	Requirements specified in the medical policy have been met
CG	Policy criteria applied
GA	Waiver of liability statement issued as required by payer policy, individual case
BP	The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GP	Services delivered under an outpatient physical therapy plan of care
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
J5	Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KV	Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
LT	Left side (used to identify procedures performed on the left side of the body)
NU	New equipment
RA	Replacement of a dme, orthotic or prosthetic item
ST	Related to trauma or injury