L0639 — Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, 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

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)

Face-to-face & WOPD

Required (Orthoses)

MUE unit limit

1

Status

Active (HCPCS Level II October 2026)

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 L0639 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). 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.