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    v1.0.30
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l0160-cervical-semi-rigid-occipital-mandibular-support
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    HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

    HCPCS Level II code L0160 describes a prefabricated, off-the-shelf cervical semi-rigid wire-frame occipital/mandibular support used to immobilize and support the head and neck; the service type is orthotic appliance (cervical occipital-mandibular support) and the typical site of service is outpatient clinic, orthotics/prosthetics provider, or durable medical equipment supplier.

    For related coverage guidance, see recent payer policy updates: Hospital Beds Corporate Medical Policy, Patient Lifts, Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient presents to an outpatient orthotics clinic following cervical spine decompression for cervical spondylotic myelopathy and requires a semi-rigid occipital-mandibular cervical support while healing. The device L0160 (cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf) is selected to provide occipital and mandibular stabilization to limit neck motion and reduce axial load during the immediate postoperative and early rehabilitation period. The clinical workflow typically includes: referral from the neurosurgeon or orthopedic spine surgeon; evaluation by a certified orthotist or durable medical equipment (DME) supplier to confirm fit and contraindications; measurement and selection of the appropriate prefabricated size; patient instruction on donning/doffing, skin checks, and wear schedule; documentation of medical necessity in the chart including operative report or clinic note; delivery and verification of fit; and follow-up with the referring surgeon or orthotist to assess tolerance, skin integrity, and continued need. Typical sites of service are outpatient orthotics/prosthetics clinics, hospital outpatient departments, and ambulatory surgery centers for immediate postoperative fitting. Typical patient scenarios include postoperative cervical stabilization, acute cervical strain with instability where a semi-rigid support is indicated, and palliative immobilization for metastatic cervical spine disease when rigid immobilization is not required or tolerated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, upper extremity, lower extremity, and/or trunk, initial encounter; includes assessment and fitting when orthosis is providedCommonly billed when comprehensive orthotic assessment, fitting, and patient training accompany delivery of L0160.
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or procedureUsed when additional supplies (padding, straps, replacement liners) are provided with the prefabricated cervical support.
    99203Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutesMay be used for initial evaluation and documentation of medical necessity prior to device provision.
    99080Special reports such as treatment summaries, except as part of a billable encounterUsed when detailed justification documentation is furnished for payer prior authorization or appeal.
    A9280Non-covered item or service; specify (often used for miscellaneous orthotic supplies)Occasionally used by suppliers when a specific HCPCS is not recognized by a payer; usage depends on payer policy and should be supported by documentation.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    225100000X
    2084P0800X
    261QP2300X
    207K00000X
    373H00000X
    2251S0007X
    3336C0004X
    133N00000X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    G44.1Vascular headache, not elsewhere classified
    G44.209Tension-type headache, unspecified, not intractable
    G44.89Other headache syndrome
    M48.02Spinal stenosis, cervical region
    M50.00Cervical disc disorder with myelopathy, unspecified cervical region
    M50.01Cervical disc disorder with myelopathy, high cervical region
    M50.10Cervical disc disorder with radiculopathy, unspecified cervical region
    M50.11Cervical disc disorder with radiculopathy, high cervical region
    M50.20Other cervical disc displacement, unspecified cervical region
    M50.21Other cervical disc displacement, high cervical region

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Hospital Beds Corporate Medical Policybcbsvermont2027-01-01
    Patient Liftsuniverahealthcare2026-11-16
    Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failureexcellus_health_plan_inc2026-10-15
    Positive Airway Pressure Devices for Pulmonary Disorders Continued RentalCareSource Georgia2026-10-01
    Bone Growth StimulatorsProvidence Health Plan2026-10-01
    Durable Medical Equipment (DME) Medical Necessity and CoverageMass General Brigham Health Plan2026-10-01
    Speech Generating DevicesMass General Brigham Health Plan2026-10-01
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01

    Related Codes

    HCPCS-L0112-CRANIAL-CERVICAL-ORTHOSIS-CONGENITAL-TORTICOLLIS-CUSTOM

    HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

    HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

    HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

    HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

    HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

    HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

    HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

    HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

    HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

    HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

    HCPCS Level II L0170: Cervical Collar, Custom-Molded

    HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

    HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

    HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

    HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

    HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

    HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

    HCPCS-L0190-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-SUPPORT

    HCPCS L0190: Cervical Multiple Post Collar with Occipital/Mandibular Supports

    Showing 1–10 of 466

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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