Question 1

What is HCPCS code L0642?

Accepted Answer

HCPCS code L0642 is "Lo sag ri an/pos pnl pre ots". Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Question 2

What category is L0642 in?

Accepted Answer

L0642 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L0642?

Accepted Answer

Use L0642 when billing for lo sag ri an/pos pnl pre ots. 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 L0642 covered by Medicare?

Accepted Answer

Coverage for L0642 (Lo sag ri an/pos pnl pre ots) 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 L0642?

Accepted Answer

Documentation for L0642 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).