L0636 — 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
HCPCS Level II L-code · short descriptor: “Lso sagittal rigid panel cus”
- 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
- Face-to-face & WOPD
- Required (Orthoses)
- 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.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
F2F + WOPD REQUIRED L0636 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — list effective 2026-04-13, 83 items). Two extra conditions of payment apply:
- Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
- Written order communicated to the supplier before delivery (WOPD)
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
L0636 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1518.13 to $2722.52 depending on state and rural status.
Former-CBA payment limits: ceiling $2171.08 · floor $1628.31
| State | Non-rural | Rural |
|---|---|---|
| AK | $2546.04 | — |
| AL | $1938.77 | — |
| AR | $1657.19 | — |
| AZ | $2171.08 | — |
| CA | $2171.08 | — |
| CO | $1914.09 | — |
| CT | $1810.39 | — |
| DC | $1628.31 | — |
| DE | $1628.31 | — |
| FL | $1938.77 | — |
| GA | $1938.77 | — |
| HI | $2722.52 | — |
| IA | $2023.15 | — |
| ID | $1652.62 | — |
| IL | $1666.22 | — |
| IN | $1666.22 | — |
| KS | $2023.15 | — |
| KY | $1938.77 | — |
| LA | $1657.19 | — |
| MA | $1810.39 | — |
| MD | $1628.31 | — |
| ME | $1810.39 | — |
| MI | $1666.22 | — |
| MN | $1666.22 | — |
| MO | $2023.15 | — |
| MS | $1938.77 | — |
| MT | $1914.09 | — |
| NC | $1938.77 | — |
| ND | $1914.09 | — |
| NE | $2023.15 | — |
| NH | $1810.39 | — |
| NJ | $1734.18 | — |
| NM | $1657.19 | — |
| NV | $2171.08 | — |
| NY | $1734.18 | — |
| OH | $1666.22 | — |
| OK | $1657.19 | — |
| OR | $1652.62 | — |
| PA | $1628.31 | — |
| PR | $1518.13 | — |
| RI | $1810.39 | — |
| SC | $1938.77 | — |
| SD | $1914.09 | — |
| TN | $1938.77 | — |
| TX | $1657.19 | — |
| UT | $1914.09 | — |
| VA | $1628.31 | — |
| VI | $1734.18 | — |
| VT | $1810.39 | — |
| WA | $1652.62 | — |
| WI | $1666.22 | — |
| WV | $1628.31 | — |
| WY | $1914.09 | — |
Common denial codes to watch
Related L-codes
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