L0637 — Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, 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, 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: “Lso sc r ant/pos pnl pre cst” · PA required
- 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
- Required (Medicare, since 2024-08-12)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED L0637 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2024-08-12).
Claims for this item without an affirmed prior-authorization decision are automatically denied (commonly surfacing as CO-197). Submit the PA request to your DME MAC with the order and supporting clinical documentation before delivery.
L0637 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1288.60 to $1682.10 depending on state and rural status.
Former-CBA payment limits: ceiling $1718.13 · floor $1288.60
| State | Non-rural | Rural |
|---|---|---|
| AK | $1487.04 | — |
| AL | $1682.10 | — |
| AR | $1501.02 | — |
| AZ | $1451.22 | — |
| CA | $1451.22 | — |
| CO | $1288.60 | — |
| CT | $1404.53 | — |
| DC | $1288.60 | — |
| DE | $1288.60 | — |
| FL | $1682.10 | — |
| GA | $1682.10 | — |
| HI | $1590.09 | — |
| IA | $1456.55 | — |
| ID | $1348.20 | — |
| IL | $1592.13 | — |
| IN | $1592.13 | — |
| KS | $1456.55 | — |
| KY | $1682.10 | — |
| LA | $1501.02 | — |
| MA | $1404.53 | — |
| MD | $1288.60 | — |
| ME | $1404.53 | — |
| MI | $1592.13 | — |
| MN | $1592.13 | — |
| MO | $1456.55 | — |
| MS | $1682.10 | — |
| MT | $1288.60 | — |
| NC | $1682.10 | — |
| ND | $1288.60 | — |
| NE | $1456.55 | — |
| NH | $1404.53 | — |
| NJ | $1288.60 | — |
| NM | $1501.02 | — |
| NV | $1451.22 | — |
| NY | $1288.60 | — |
| OH | $1592.13 | — |
| OK | $1501.02 | — |
| OR | $1348.20 | — |
| PA | $1288.60 | — |
| PR | $1427.66 | — |
| RI | $1404.53 | — |
| SC | $1682.10 | — |
| SD | $1288.60 | — |
| TN | $1682.10 | — |
| TX | $1501.02 | — |
| UT | $1288.60 | — |
| VA | $1288.60 | — |
| VI | $1288.60 | — |
| VT | $1404.53 | — |
| WA | $1348.20 | — |
| WI | $1592.13 | — |
| WV | $1288.60 | — |
| WY | $1288.60 | — |
Common denial codes to watch
Related L-codes
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