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HCPCS L0626 · Level II · orthotic and prosthetic code

L0626: Lumbar orthosis, sagittal control, with rigid posterior panel(s), HCPCS Level II orthotic and prosthetic code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for L0626

Medicare payment
$93.48 to $97.02
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

CMS describes HCPCS L0626, added in 2006, as "Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise". The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L0626 at $93.48 in AZ, CA, CT and 17 more to $97.02 in CO, MT, ND and 3 more (floor $85.59, ceiling $114.12). CMS caps L0626 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 2, Anatomic Consideration); DME supplier 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. 1 active LCD lists L0626: L33790 (Spinal Orthoses: TLSO and LSO). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 4 other active codes open with "Lumbar orthosis"; related codes: L0625, L0627, L0641, L0642.

L0626 descriptor and code status

The October 2026 HCPCS Level II file describes L0626 as “Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L0626
FieldValue
Short descriptorLo sag rig pnl stays pre cst
Added to HCPCS2006-01-01
Last actionN (no maintenance), effective 2014-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L0626

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L0626 at $93.48 in AZ, CA, CT and 17 more to $97.02 in CO, MT, ND and 3 more (floor $85.59, ceiling $114.12). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category PO (prosthetics and orthotics). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for L0626 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$85.59 / $114.12$93.48 (AZ, CA, CT…) to $97.02 (CO, MT, ND…)—AK $93.48, HI $93.48, PR $102.83, VI $102.83

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for L0626

CMS caps L0626 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 2, Anatomic Consideration); DME supplier 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for L0626 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital12 Date of Service Edit: PolicyAnatomic Consideration
DME supplier12 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for L0626 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L0626 in v323r0.

L0626 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check L0626 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L0626

1 active Local Coverage Determination and 0 billing and coding articles list L0626. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on L0626

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L0626

CARC 151 · N362

units of L0626 exceed the DME supplier MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Prior authorization in Original Medicare

  • Newly enrolled DMEPOS suppliers, and suppliers after certain changes of ownership, need prior authorization for this item during their probationary year, for enrollments approved on or after October 15, 2026. CMS service group: Orthoses.

Medicare Advantage plans run their own prior authorization lists. See this code on the Medicare prior authorization list.

Where QuickIntell fits for L0626 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L0626 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L0626

What does HCPCS code L0626 describe?

"Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise" (short descriptor "Lo sag rig pnl stays pre cst"), in the L section (orthotic and prosthetic procedures and devices). Added 2006-01-01; last action N (no maintenance) effective 2014-01-01.

Is L0626 a CPT code?

It is not. L0626 belongs to the L section (orthotic and prosthetic procedures and devices) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for L0626?

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L0626 at $93.48 in AZ, CA, CT and 17 more to $97.02 in CO, MT, ND and 3 more (floor $85.59, ceiling $114.12).

How many units of L0626 can be billed per day?

CMS caps L0626 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 2, Anatomic Consideration); DME supplier 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover L0626?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists L0626: L33790 (Spinal Orthoses: TLSO and LSO).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.