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Linda Collins Blogger

Coding for Spinal Braces

Posted by Linda Collins | May 03, 2017

Spinal Orthoses have specific HCPCS codes for each product and for the type of product, off the shelf, custom-fit, or custom.  One additional requirement is that spinal orthoses must receive a coding verification review from PDAC in order to be considered a covered item.

HCPCS Coding

Spinal braces may be off the shelf, custom-fit or custom fabricated. The off the shelf brace and custom-fit brace are both considered prefabricated. The difference is dependent upon whether there is a need for only minimal self-adjustment or substantial modifications at the time of delivery. Items requiring only minimal self-adjustment, defined as the type of adjustments a patient or caretaker can perform without input from an individual with training, are considered off the shelf. The same brace may be considered custom-fit if substantial modifications are made, at the time of fitting, to achieve an individualized fit and require the skills of an expert. The substantial modifications must be well documented in the medical records.

There are spinal braces that may be either off the shelf or custom-fit. The only difference in the codes is the adjustments made at time of final fitting. Here is a list of Össur products with both off the shelf and custom fit codes:

Off the Shelf Custom Fit
Miami Lumbar BeltL0641L0626
Miami Lumbar Belt & Anterior PanelL0642L0627
Miami Lumbar Belt & Anterior Panel & Lateral Posterior PanelL0650L0637
Miami Lumbar Belt & Anterior Panel & Non-lateral Posterior PanelL0648L0631
Miami Lumbar Belt & Lateral Posterior PanelL0649L0633
Miami Lumbar Belt & Non-lateral Posterior PanelL0643L0630
Miami Lumbar PosteoL0457L0456
OAM  Rigid Lumbar Belt & Non-lateral Posterior PanelL0643L0630
OAM Rigid Lumbar BeltL0641L0626
OAM Rigid Lumbar Belt & Anterior PanelL0642L0627
OAM Rigid Lumbar Belt & Anterior Panel & Lateral Posterior PanelL0650L0637
OAM Rigid Lumbar Belt & Anterior Panel & Non-lateral Posterior PanelL0648L0631
OAM Rigid Lumbar Belt OTSL0641L0626


If a custom fit code is billed but there was not documentation to support the substantial modifications made at time of fitting, the claim will be denied as a non-covered item.

A custom fabricated spinal orthosis (L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638 and L0640), is defined as one that is made individually for a specific patient. It involves substantial work and may or may not involve molding. In order to provide a custom fabricated back brace, the physician's prescription must specify "custom fabricated." The physician's medical records must also support the medical necessity of a custom brace. Custom braces may be needed when there are abnormal body shapes, other medical conditions, or long term use due to a chronic condition.

PDAC Verification

In order to bill spinal braces to Medicare, there must be coding verification by the Pricing, Data Analysis, and Coding (PDAC) contractor. You do not need a copy of the actual PDAC Coding Verification letter from the manufacturer, but you do need to verify the listing on

More information about Spinal Orthoses coding requirements can be found in the LCD (L33790) and the Policy Article (A55426.)

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