L0634
Prosthetics & Orthotics
53 States
Lumbar-sacral orthosis, sagittal-coronal control, with rigid 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, stays, shoulder straps, pendulous abdomen design, custom fabricated
Short Desc
Lso flexion control custom
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$0.00
|
Same |
|
AL
|
Base Rate |
$0.00
|
Same |
|
AR
|
Base Rate |
$0.00
|
Same |
|
AZ
|
Base Rate |
$0.00
|
Same |
|
CA
|
Base Rate |
$0.00
|
Same |
|
CO
|
Base Rate |
$0.00
|
Same |
|
CT
|
Base Rate |
$0.00
|
Same |
|
DC
|
Base Rate |
$0.00
|
Same |
|
DE
|
Base Rate |
$0.00
|
Same |
|
FL
|
Base Rate |
$0.00
|
Same |
|
GA
|
Base Rate |
$0.00
|
Same |
|
HI
|
Base Rate |
$0.00
|
Same |
|
IA
|
Base Rate |
$0.00
|
Same |
|
ID
|
Base Rate |
$0.00
|
Same |
|
IL
|
Base Rate |
$0.00
|
Same |
|
IN
|
Base Rate |
$0.00
|
Same |
|
KS
|
Base Rate |
$0.00
|
Same |
|
KY
|
Base Rate |
$0.00
|
Same |
|
LA
|
Base Rate |
$0.00
|
Same |
|
MA
|
Base Rate |
$0.00
|
Same |
|
MD
|
Base Rate |
$0.00
|
Same |
|
ME
|
Base Rate |
$0.00
|
Same |
|
MI
|
Base Rate |
$0.00
|
Same |
|
MN
|
Base Rate |
$0.00
|
Same |
|
MO
|
Base Rate |
$0.00
|
Same |
|
MS
|
Base Rate |
$0.00
|
Same |
|
MT
|
Base Rate |
$0.00
|
Same |
|
NC
|
Base Rate |
$0.00
|
Same |
|
ND
|
Base Rate |
$0.00
|
Same |
|
NE
|
Base Rate |
$0.00
|
Same |
|
NH
|
Base Rate |
$0.00
|
Same |
|
NJ
|
Base Rate |
$0.00
|
Same |
|
NM
|
Base Rate |
$0.00
|
Same |
|
NV
|
Base Rate |
$0.00
|
Same |
|
NY
|
Base Rate |
$0.00
|
Same |
|
OH
|
Base Rate |
$0.00
|
Same |
|
OK
|
Base Rate |
$0.00
|
Same |
|
OR
|
Base Rate |
$0.00
|
Same |
|
PA
|
Base Rate |
$0.00
|
Same |
|
PR
|
Base Rate |
$0.00
|
Same |
|
RI
|
Base Rate |
$0.00
|
Same |
|
SC
|
Base Rate |
$0.00
|
Same |
|
SD
|
Base Rate |
$0.00
|
Same |
|
TN
|
Base Rate |
$0.00
|
Same |
|
TX
|
Base Rate |
$0.00
|
Same |
|
UT
|
Base Rate |
$0.00
|
Same |
|
VA
|
Base Rate |
$0.00
|
Same |
|
VI
|
Base Rate |
$0.00
|
Same |
|
VT
|
Base Rate |
$0.00
|
Same |
|
WA
|
Base Rate |
$0.00
|
Same |
|
WI
|
Base Rate |
$0.00
|
Same |
|
WV
|
Base Rate |
$0.00
|
Same |
|
WY
|
Base Rate |
$0.00
|
Same |