MyMedi-AI

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.

StateNon-ruralRural
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
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

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

Bill L0651 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, L0651 included, and starter credits via POST /bot-marketplace/register.