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    v1.0.30
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l0172-cervical-collar-semi-rigid-thermoplastic-foam
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    HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

    HCPCS Level II code L0172 describes a prefabricated, off-the-shelf two-piece semi-rigid thermoplastic foam cervical collar (cervical, collar, semi-rigid thermoplastic foam, two-piece) used to provide neck immobilization and support; the service type is orthotic device fitting/provision, and the typical site of service is outpatient clinic, durable medical equipment supplier, or ambulatory care setting where the device is fitted and dispensed.

    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 57-year-old patient presents to an outpatient orthotics clinic with subacute neck pain and limited cervical range of motion following a ground-level fall two weeks prior. The patient reports axial neck pain with intermittent occipital headaches but no focal neurological deficits. Physical exam demonstrates cervical muscle spasm and point tenderness over the lower cervical spine. Cervical imaging (radiographs) ordered by the treating primary care physician shows no unstable fracture. The clinician prescribes a prefabricated semi-rigid cervical collar for symptomatic immobilization and support while the patient undergoes a short course of physical therapy and analgesia.

    In the clinical workflow: the prescribing clinician (primary care physician, physiatrist, emergency physician, or orthopedic/sports medicine specialist) documents the diagnosis and functional limitation in the medical record, selects the appropriate off-the-shelf device described by billing code L0172, and provides the patient with the two-piece semi-rigid thermoplastic foam cervical collar. Durable medical equipment (DME) staff or clinic personnel fit and instruct the patient on use, document item model/size, apply required modifiers on the claim as appropriate, and submit the claim with the supporting clinical notes and any applicable prior authorization or Medical Necessity documentation to the payer.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommonly used for the clinician visit during which the need for a cervical collar is assessed, documented, and ordered.
    97110Therapeutic exercises to develop strength and endurance, range of motion and flexibility (15 minutes)Frequently provided in follow-up physical therapy visits after collar provision to restore cervical mobility while protected.
    97010Application of a modality to one or more areas; hot or cold packsOften used in adjunctive therapy for cervical muscle spasm concurrent with orthotic use.
    99070Supplies and materials provided by the physician over and above those usually included with the office visitMay be used when additional fitting supplies or padding are provided alongside the prefabricated collar.
    A9270Non-covered item or service (used for DME miscellaneous)Sometimes used by suppliers for billing non-covered or miscellaneous orthotic supplies when payer guidelines require it.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    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…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    207L00000X
    163W00000X
    364S00000X
    2084D0003X
    163WE0900X
    103TE1100X
    207LP3000X

    Related ICD-10-CM Codes

    19 rows

    ICD-10-CM CodeDescription
    M48.02Spinal stenosis, cervical region
    M48.04Spinal stenosis, thoracic 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
    M50.30Other cervical disc degeneration, unspecified cervical region
    M53.2X1Spinal instabilities, occipito-atlanto-axial region
    M53.2X2Spinal instabilities, cervical region
    M54.12Radiculopathy, cervical region

    Showing 1–10 of 19

    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-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

    HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

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

    HCPCS Level II L0170: Cervical Collar, Custom-Molded

    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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