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-shelf1
active · OTS Back
This is a summary page. It covers the descriptor, the governing policy and the headline rules. The coverage criteria, documentation requirements and fee detail have not yet been read against the governing LCD in full.
At a glance
Medicare baseline
From the October 2026 DMEPOS fee schedule, file DME26-D, effective October 1, 2026. Each amount is the per-state figure CMS labels as used for pricing claims, and jurisdictions that share an amount share a row. The first row is the amount most jurisdictions share; a jurisdiction not named in another non-rural row is in it.
This code also has a separate amount for rural ZIP codes, in the rows that start "Rural ZIP codes in"; the rows before them are the non-rural amounts. The file gives no rural amount for the jurisdictions the rural rows do not name.
| Jurisdiction | Medicare allowable |
|---|---|
| 18 states | $137.13 |
| California, Nevada, Oregon and Washington | $60.40 |
| Colorado, Idaho, Montana, Utah and Wyoming | $90.01 |
| Illinois, Indiana, Michigan, Ohio and Wisconsin | $116.41 |
| Delaware, Maryland, New Jersey, New York, Pennsylvania and the District of Columbia | $120.32 |
| Arizona, New Mexico, Oklahoma and Texas | $129.31 |
| Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota | $134.44 |
| Alaska and Hawaii | $202.05 |
| Puerto Rico and the U.S. Virgin Islands | $212.69 |
| Rural ZIP codes in Arizona, California, Connecticut, Delaware, Idaho, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, West Virginia and the District of Columbia | $174.69 |
| Rural ZIP codes in Iowa, Kansas, Missouri and Nebraska | $176.77 |
| Rural ZIP codes in Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin | $177.31 |
| Rural ZIP codes in Arkansas, Louisiana, New Mexico, Oklahoma and Texas | $177.90 |
| Rural ZIP codes in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee | $177.91 |
| Rural ZIP codes in Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming | $178.51 |
Sources
- [1] HCPCS Level II Alpha-Numeric File, October 2026 quarterly update · Centers for Medicare and Medicaid Services · checked 2026-11-05
Downloaded on 2026-11-05 from https://www.cms.gov/files/zip/october-2026-alpha-numeric-hcpcs-file.zip, HTTP 200, 2,518,755 bytes, SHA-256 08c2202fa92c1d1fb6f31b808b61c767bc487954f6930b6a0f8d09c89af5992f; the data file inside is HCPC2026_OCT_ANWEB_09232026.txt and the field positions are documented in HCPC2026_recordlayout.txt in the same archive. Read for all 156 codes this hub has a page for. Every one is present, none carries a termination date, and every one has action code N, no maintenance in this release. The long descriptors of the 153 codes in the Round 2028 product category list, rejoined across the 80-character continuation records, match this file word for word, ignoring case.
Reviewed 2026-11-05 by the Round 2028 code list, not yet by a person
PayorTransparency tracks how commercial payers price L0623, from the transparency files they publish each month. Book a call