Question 1

What is HCPCS code L0639?

Accepted Answer

HCPCS code L0639 is "Lso s/c shell/panel prefab". Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Question 2

What category is L0639 in?

Accepted Answer

L0639 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L0639?

Accepted Answer

Use L0639 when billing for lso s/c shell/panel prefab. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L0639 covered by Medicare?

Accepted Answer

Coverage for L0639 (Lso s/c shell/panel prefab) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L0639?

Accepted Answer

Documentation for L0639 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).