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HCPCS
L0636

HCPCS Code L0636

Official Description

Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
Short Descr Lso sagittal rigid panel cus
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 No
CCS Clinical Classification 243 - DME and supplies
GA Waiver of liability statement issued as required by payer policy, individual case
KX Requirements specified in the medical policy have been met
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
Code
Description
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