L0651 — 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, off-the-shelf
HCPCS Level II L-code · short descriptor: “Lso sag-co shell pnl pre ots” · 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 2026-04-13)
- Face-to-face & WOPD
- Required (Orthoses)
- MUE unit limit
- 1
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
PA REQUIRED L0651 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2026-04-13).
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.
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 L0651 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.
L0651 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $406.45 to $1440.51 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1388.99 | — |
| AL | $922.75 | $1302.42 |
| AR | $922.75 | $1211.87 |
| AZ | $870.15 | $1186.97 |
| CA | $406.45 | $1186.97 |
| CO | $605.72 | $1105.67 |
| CT | $922.75 | $1163.63 |
| DC | $809.61 | $1105.67 |
| DE | $809.61 | $1105.67 |
| FL | $922.75 | $1302.42 |
| GA | $922.75 | $1302.42 |
| HI | $1440.51 | — |
| IA | $904.66 | $1189.64 |
| ID | $605.72 | $1135.46 |
| IL | $783.31 | $1257.43 |
| IN | $783.31 | $1257.43 |
| KS | $904.66 | $1189.64 |
| KY | $922.75 | $1302.42 |
| LA | $922.75 | $1211.87 |
| MA | $922.75 | $1163.63 |
| MD | $809.61 | $1105.67 |
| ME | $922.75 | $1163.63 |
| MI | $783.31 | $1257.43 |
| MN | $904.66 | $1257.43 |
| MO | $904.66 | $1189.64 |
| MS | $922.75 | $1302.42 |
| MT | $605.72 | $1105.67 |
| NC | $922.75 | $1302.42 |
| ND | $904.66 | $1105.67 |
| NE | $904.66 | $1189.64 |
| NH | $922.75 | $1163.63 |
| NJ | $809.61 | $1105.67 |
| NM | $870.15 | $1211.87 |
| NV | $406.45 | $1186.97 |
| NY | $809.61 | $1105.67 |
| OH | $783.31 | $1257.43 |
| OK | $870.15 | $1211.87 |
| OR | $406.45 | $1135.46 |
| PA | $809.61 | $1105.67 |
| PR | $1359.30 | — |
| RI | $922.75 | $1163.63 |
| SC | $922.75 | $1302.42 |
| SD | $904.66 | $1105.67 |
| TN | $922.75 | $1302.42 |
| TX | $870.15 | $1211.87 |
| UT | $605.72 | $1105.67 |
| VA | $922.75 | $1105.67 |
| VI | $1288.60 | — |
| VT | $922.75 | $1163.63 |
| WA | $406.45 | $1135.46 |
| WI | $783.31 | $1257.43 |
| WV | $922.75 | $1105.67 |
| WY | $605.72 | $1105.67 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L0651 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related L-codes
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