L0625 — Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf
HCPCS Level II L-code · short descriptor: “Lo flex l1-below l5 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.
L0625 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $18.85 to $66.28 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $62.97 | — |
| AL | $42.80 | $55.45 |
| AR | $42.80 | $55.44 |
| AZ | $40.36 | $54.43 |
| CA | $18.85 | $54.43 |
| CO | $28.10 | $55.70 |
| CT | $42.80 | $54.43 |
| DC | $37.55 | $54.43 |
| DE | $37.55 | $54.43 |
| FL | $42.80 | $55.45 |
| GA | $42.80 | $55.45 |
| HI | $62.97 | — |
| IA | $41.96 | $55.08 |
| ID | $28.10 | $54.43 |
| IL | $36.33 | $55.25 |
| IN | $36.33 | $55.25 |
| KS | $41.96 | $55.08 |
| KY | $42.80 | $55.45 |
| LA | $42.80 | $55.44 |
| MA | $42.80 | $54.43 |
| MD | $37.55 | $54.43 |
| ME | $42.80 | $54.43 |
| MI | $36.33 | $55.25 |
| MN | $41.96 | $55.25 |
| MO | $41.96 | $55.08 |
| MS | $42.80 | $55.45 |
| MT | $28.10 | $55.70 |
| NC | $42.80 | $55.45 |
| ND | $41.96 | $55.70 |
| NE | $41.96 | $55.08 |
| NH | $42.80 | $54.43 |
| NJ | $37.55 | $54.43 |
| NM | $40.36 | $55.44 |
| NV | $18.85 | $54.43 |
| NY | $37.55 | $54.43 |
| OH | $36.33 | $55.25 |
| OK | $40.36 | $55.44 |
| OR | $18.85 | $54.43 |
| PA | $37.55 | $54.43 |
| PR | $66.28 | — |
| RI | $42.80 | $54.43 |
| SC | $42.80 | $55.45 |
| SD | $41.96 | $55.70 |
| TN | $42.80 | $55.45 |
| TX | $40.36 | $55.44 |
| UT | $28.10 | $55.70 |
| VA | $42.80 | $54.43 |
| VI | $66.28 | — |
| VT | $42.80 | $54.43 |
| WA | $18.85 | $54.43 |
| WI | $36.33 | $55.25 |
| WV | $42.80 | $54.43 |
| WY | $28.10 | $55.70 |
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
Bill L0625 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →