2025 HCPCS Code 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

TAGS: custom abdomen pendulous sacroiliac about fabricated sacrum reduces include rigid provides placed panels motion

Short Description	Sio panel custom
HCPCS Action Code	N - No maintenance for this code
HCPCS Coverage Code	C - Carrier judgment
HCPCS Code Added Date	January 01, 2006
HCPCS Action Effective Date	January 01, 2006
HCPCS Pricing Indicator Code	38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
HCPCS Type Of Service Code	P - Lump sum purchase of DME, prosthetics, orthotics
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Coverage Issues Manual Reference Section Number