L0626 — 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
HCPCS Level II L-code · short descriptor: “Lo sag rig pnl stays pre cst”
- 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.
L0626 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $93.48 to $102.83 depending on state and rural status.
Former-CBA payment limits: ceiling $114.12 · floor $85.59
| State | Non-rural | Rural |
|---|---|---|
| AK | $93.48 | — |
| AL | $96.32 | — |
| AR | $96.31 | — |
| AZ | $93.48 | — |
| CA | $93.48 | — |
| CO | $97.02 | — |
| CT | $93.48 | — |
| DC | $93.48 | — |
| DE | $93.48 | — |
| FL | $96.32 | — |
| GA | $96.32 | — |
| HI | $93.48 | — |
| IA | $95.33 | — |
| ID | $93.48 | — |
| IL | $95.79 | — |
| IN | $95.79 | — |
| KS | $95.33 | — |
| KY | $96.32 | — |
| LA | $96.31 | — |
| MA | $93.48 | — |
| MD | $93.48 | — |
| ME | $93.48 | — |
| MI | $95.79 | — |
| MN | $95.79 | — |
| MO | $95.33 | — |
| MS | $96.32 | — |
| MT | $97.02 | — |
| NC | $96.32 | — |
| ND | $97.02 | — |
| NE | $95.33 | — |
| NH | $93.48 | — |
| NJ | $93.48 | — |
| NM | $96.31 | — |
| NV | $93.48 | — |
| NY | $93.48 | — |
| OH | $95.79 | — |
| OK | $96.31 | — |
| OR | $93.48 | — |
| PA | $93.48 | — |
| PR | $102.83 | — |
| RI | $93.48 | — |
| SC | $96.32 | — |
| SD | $97.02 | — |
| TN | $96.32 | — |
| TX | $96.31 | — |
| UT | $97.02 | — |
| VA | $93.48 | — |
| VI | $102.83 | — |
| VT | $93.48 | — |
| WA | $93.48 | — |
| WI | $95.79 | — |
| WV | $93.48 | — |
| WY | $97.02 | — |
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 L0626 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 →