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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l0625-lumbar-orthosis-flexible-l1-to-l5
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    HCPCS Level II L0625: Flexible Lumbar Orthosis, Prefabricated

    HCPCS Level II code L0625 describes a prefabricated, off-the-shelf flexible lumbar orthosis that provides lumbar support with a posterior panel extending from L1 to below L5, includes straps and closures, and produces intracavitary pressure to reduce load on intervertebral discs; service type: provision and fitting of a lumbar support orthosis; typical site of service: durable medical equipment suppliers, outpatient orthotics/prosthetics clinics, or outpatient rehabilitation settings.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical Guideline, Durable Medical Equipment (DME): Bone Growth Stimulators Medical Guideline.

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    Table of contents

    Progress1 / 7

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    Clinical & Coding Specifications

    Clinical Context

    A 56-year-old patient presents to an outpatient orthopedic clinic with subacute low back pain radiating to the lumbar paraspinal region, worse with prolonged standing and bending. Examination reveals lumbar paraspinal muscle tenderness, reduced lumbar range of motion, and exacerbation of pain with axial loading. Imaging (lumbar radiographs or MRI) demonstrates degenerative disc disease at L4–L5 with anterior disc height loss and facet arthropathy. The treating spine specialist or orthotist documents failed conservative management (physical therapy, NSAIDs, activity modification) and prescribes a prefabricated flexible lumbar orthosis to provide trunk support and increase intra-abdominal pressure to unload the intervertebral discs.

    Typical clinical workflow:

    • Initial evaluation by a spine specialist, physiatrist, or orthopedic surgeon including history, physical exam, and review of prior imaging.

    • Documentation of medical necessity for a lumbar orthosis (persistent pain despite conservative care, functional limitation, or temporary support post-injury/surgery).

    • Order placed for a prefabricated lumbar orthosis described by billing code L0625 (flexible lumbar orthosis, posterior extends from L1 to below L5, includes straps/closures; off-the-shelf).

    • Measurement and fitting in the clinic or by a certified orthotist; patient education on wear schedule and skin inspection.

    • Follow-up visit to assess symptom relief, device fit, and need for continued use or progression to a custom orthosis if inadequate relief.

    Typical site of service: outpatient orthopedics, physiatry clinic, durable medical equipment (DME) supplier, or rehabilitation clinic.

    Typical patient scenario: adult with degenerative lumbar disc disease, lumbar strain/sprain, post-laminectomy support, or temporary mechanical low back pain requiring a prefabricated lumbar support for symptom control and functional improvement.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed for the clinic visit where the lumbar orthosis is evaluated, ordered, and documented for medical necessity
    97001Physical therapy evaluation — initialPerformed when physical therapy precedes or accompanies orthosis use to document conservative care trials
    99203Office or other outpatient visit for a new patient, typically 30 minutesUsed for initial evaluation of a new patient being considered for a lumbar orthosis
    97530Therapeutic activities, direct (one-on-one) patient contactOften part of rehabilitation program before or concurrent with bracing to improve function

    Related Modifiers

    5 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…
    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…
    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…
    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 CodeSpecialtyNotes
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    3336C0002XClinic PharmacyA pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    2084P0802XAddiction Psychiatry PhysicianAddiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-re…
    207LP4000XPhysician Nutrition Specialist (Anesthesiology)A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…
    211D00000XPodiatric AssistantAn individual who assists a podiatrist in tasks, such as exposing and developing x-rays; taking and recording patient histories; assisting in biomecha…
    133VN1005XRenal Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury,…

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    M43.16Spondylolisthesis, lumbar region
    M43.17Spondylolisthesis, lumbosacral region
    M47.816Spondylosis without myelopathy or radiculopathy, lumbar region
    M47.817Spondylosis without myelopathy or radiculopathy, lumbosacral region
    M48.07Spinal stenosis, lumbosacral region
    M51.24Other intervertebral disc displacement, thoracic region
    M51.25Other intervertebral disc displacement, thoracolumbar region
    M51.26Other intervertebral disc displacement, lumbar region
    M51.27Other intervertebral disc displacement, lumbosacral region
    M53.2X6Spinal instabilities, lumbar region

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    5 rows

    PolicyPayerEffective Date
    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
    General Durable Medical Equipment (DME) Medical GuidelineWPS Health Insurance2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    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-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

    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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    97161
    Physical therapy evaluation: low complexity
    Alternate PT evaluation code used in outpatient settings to document conservative management
    99406Smoking and tobacco use cessation counseling visitProvided as part of comprehensive care for patients with degenerative spine disease when counseling is relevant