Lumbar-Sacral Back Brace

HCPCS L0650 is a prefabricated, off-the-shelf lumbar-sacral orthosis (LSO) with rigid front and back panels. It limits bending of the lower spine and adds gentle compression around the abdomen, taking load off the lower back while it heals. Star DME sizes it to your waist and adjusts it before you leave the store.

Used for: Lower back pain, Disc support, Post-injury

Medicare
Medicaid
Commercial plans
No-Fault
Workers' Comp
Other major insurances

Check coverage for this item Call (917) 300-2692 Doctors: order form (PDF)

Medicare coverage requirements

Medicare requirements

Medicare LCD L33790, Spinal Orthoses: TLSO and LSO, with Policy Article A52500

Covered when ordered for

To reduce pain by restricting mobility of the trunk, or
To help healing after an injury to the spine or related soft tissues, or
To help healing after surgery on the spine or related soft tissue, or
To support weak spinal muscles and/or a deformed spine

Doctor's note should include

The diagnosis and which of the four LCD indications above the brace is ordered for
Your symptoms and how they affect daily activities (pain level, bending, lifting, standing, walking)
Exam findings from a recent visit with the treating practitioner
Prior treatments tried, such as medication, physical therapy or injections, when relevant
A clear statement that a lumbar-sacral orthosis is medically necessary

Prior authorization

L0650 is on the Medicare Required Prior Authorization List, so Star DME submits a prior authorization request with your doctor's records before the brace is billed.