| HCPCS Code: |
L0628 |
| Long Description: |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| Short Description: |
Lso flex no ri stays pre ots |
| Pricing Indicator 1: |
38 (Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1F (Orthotic devices) |
| Type of Service Code 1: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2006 |
| Action Effective Date: |
01-01-2014 |
| Action Code: |
C (Change in long description of procedure or modifier code) |
