L0638 HCPCS code: Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
L0638 is the HCPCS Level II code for lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $1,582.02 to $1,740.23 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 14% from 2022 to 2024 (83 to 95 services). In 2024, 51 suppliers billed Medicare for L0638 (purchases), serving 95 beneficiaries. Its average fee ranks 22 of 23 L06 codes (family range $39.75–$1,838.93).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2006-01-01 |
| Last action effective | 2006-01-01 |
2026 Medicare DMEPOS fee schedule for L0638
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,582.02 | $1,740.23 | $1,930.64 | $1,447.98 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,582.02 | — |
| AL | — | $1,629.67 | — |
| AR | — | $1,629.51 | — |
| AZ | — | $1,582.02 | — |
| CA | — | $1,582.02 | — |
| CO | — | $1,638.69 | — |
| CT | — | $1,582.02 | — |
| DC | — | $1,582.02 | — |
| DE | — | $1,582.02 | — |
| FL | — | $1,629.67 | — |
| GA | — | $1,629.67 | — |
| HI | — | $1,582.02 | — |
| IA | — | $1,612.93 | — |
| ID | — | $1,582.02 | — |
| IL | — | $1,620.91 | — |
| IN | — | $1,620.91 | — |
| KS | — | $1,612.93 | — |
| KY | — | $1,629.67 | — |
| LA | — | $1,629.51 | — |
| MA | — | $1,582.02 | — |
| MD | — | $1,582.02 | — |
| ME | — | $1,582.02 | — |
| MI | — | $1,620.91 | — |
| MN | — | $1,620.91 | — |
| MO | — | $1,612.93 | — |
| MS | — | $1,629.67 | — |
| MT | — | $1,638.69 | — |
| NC | — | $1,629.67 | — |
| ND | — | $1,638.69 | — |
| NE | — | $1,612.93 | — |
| NH | — | $1,582.02 | — |
| NJ | — | $1,582.02 | — |
| NM | — | $1,629.51 | — |
| NV | — | $1,582.02 | — |
| NY | — | $1,582.02 | — |
| OH | — | $1,620.91 | — |
| OK | — | $1,629.51 | — |
| OR | — | $1,582.02 | — |
| PA | — | $1,582.02 | — |
| PR | — | $1,740.23 | — |
| RI | — | $1,582.02 | — |
| SC | — | $1,629.67 | — |
| SD | — | $1,638.69 | — |
| TN | — | $1,629.67 | — |
| TX | — | $1,629.51 | — |
| UT | — | $1,638.69 | — |
| VA | — | $1,582.02 | — |
| VI | — | $1,740.23 | — |
| VT | — | $1,582.02 | — |
| WA | — | $1,582.02 | — |
| WI | — | $1,620.91 | — |
| WV | — | $1,582.02 | — |
| WY | — | $1,638.69 | — |
How the L0638 fee compares
| Measure | Value |
|---|---|
| Rank among 23 L06 codes (lowest = 1) | 22 |
| Family fee range (average of state fees) | $39.75–$1,838.93 |
| Rural fee uplift | — |
Who bills L0638 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 51 |
| Referring clinicians | 57 |
| Medicare beneficiaries | 95 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 55 | 83 |
| 2023 | 60 | 90 |
| 2024 | 51 | 95 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L0638, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 83 | 83 | $1,376.50 | $1,064.33 |
| 2023 | 90 | 90 | $1,499.01 | $1,170.45 |
| 2024 | 95 | 95 | $1,533.59 | $1,190.89 |
States with the most L0638 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Washington | 22 | $1,187.49 |
| Minnesota | 14 | $1,216.67 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Anatomic Consideration |
| outpatient hospital claims | 1 | Anatomic Consideration |
Medicare policy articles for this code
- A52500: Spinal Orthoses: TLSO and LSO - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for L0638
- 2026-01-01: Average state fee rose 2.0%: $1,581.19 to $1,612.81
- 2006-01-01: L0638 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L0638?
L0638 is the HCPCS Level II code for lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated. Short descriptor: "Lso sag-coronal panel custom".
How much does Medicare pay for L0638?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,582.02–$1,740.23. Rural fees can be higher.
Does Medicare cover L0638?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0638 change in 2026?
The average non-rural state fee moved from $1,581.19 in 2025 to $1,612.81 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0638 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L06 codes
- L0621 — Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf ($33.70–$127.41)
- L0622 — Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated ($265.54–$491.31)
- L0623 — Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf ($60.40–$212.69)
- L0624 — Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
- L0625 — Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf ($18.85–$66.28)
- L0626 — 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 ($93.48–$102.83)
- L0627 — Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, 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, 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 ($493.08–$542.36)
- L0628 — Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf ($28.70–$100.92)
- L0629 — Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated
- L0630 — Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 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 ($194.26–$213.67)
- L0631 — Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, 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 ($1,231.38–$1,354.47)
- L0632 — Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
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Next steps
- Run a reimbursement report for a device billed under L0638
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- Build a full Medicare revenue model for L0638
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.