L0650 — Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

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 2022-10-10)

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 L0650 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.