L0623 — Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
HCPCS Level II L-code · short descriptor: “Sio rig pnl pelv/sac pre ots”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L0623 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $60.40 to $212.69 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $202.05 | — |
| AL | $137.13 | $177.91 |
| AR | $137.13 | $177.90 |
| AZ | $129.31 | $174.69 |
| CA | $60.40 | $174.69 |
| CO | $90.01 | $178.51 |
| CT | $137.13 | $174.69 |
| DC | $120.32 | $174.69 |
| DE | $120.32 | $174.69 |
| FL | $137.13 | $177.91 |
| GA | $137.13 | $177.91 |
| HI | $202.05 | — |
| IA | $134.44 | $176.77 |
| ID | $90.01 | $174.69 |
| IL | $116.41 | $177.31 |
| IN | $116.41 | $177.31 |
| KS | $134.44 | $176.77 |
| KY | $137.13 | $177.91 |
| LA | $137.13 | $177.90 |
| MA | $137.13 | $174.69 |
| MD | $120.32 | $174.69 |
| ME | $137.13 | $174.69 |
| MI | $116.41 | $177.31 |
| MN | $134.44 | $177.31 |
| MO | $134.44 | $176.77 |
| MS | $137.13 | $177.91 |
| MT | $90.01 | $178.51 |
| NC | $137.13 | $177.91 |
| ND | $134.44 | $178.51 |
| NE | $134.44 | $176.77 |
| NH | $137.13 | $174.69 |
| NJ | $120.32 | $174.69 |
| NM | $129.31 | $177.90 |
| NV | $60.40 | $174.69 |
| NY | $120.32 | $174.69 |
| OH | $116.41 | $177.31 |
| OK | $129.31 | $177.90 |
| OR | $60.40 | $174.69 |
| PA | $120.32 | $174.69 |
| PR | $212.69 | — |
| RI | $137.13 | $174.69 |
| SC | $137.13 | $177.91 |
| SD | $134.44 | $178.51 |
| TN | $137.13 | $177.91 |
| TX | $129.31 | $177.90 |
| UT | $90.01 | $178.51 |
| VA | $137.13 | $174.69 |
| VI | $212.69 | — |
| VT | $137.13 | $174.69 |
| WA | $60.40 | $174.69 |
| WI | $116.41 | $177.31 |
| WV | $137.13 | $174.69 |
| WY | $90.01 | $178.51 |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related L-codes
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