{"id":180112,"date":"2026-08-14T08:46:13","date_gmt":"2026-08-14T08:46:13","guid":{"rendered":"https:\/\/pabau.com\/?p=180112"},"modified":"2026-08-14T10:53:50","modified_gmt":"2026-08-14T10:53:50","slug":"hcpcs-code-l0622","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-l0622\/","title":{"rendered":"HCPCS code L0622: Sacroiliac orthosis, custom fabricated"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code L0622: Sacroiliac orthosis, custom fabricated\",\"description\":\"Full billing reference for HCPCS code L0622: sacroiliac orthosis, flexible, custom fabricated. Covers Medicare coverage, documentation requirements, modifiers, related codes, and common denials.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-l0622\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-12\",\"dateModified\":\"2026-08-14\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code L0622 describes a flexible, custom fabricated sacroiliac orthosis that supports the pelvis and limits motion at the SI joint.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>L0622 is a DMEPOS code billed under Medicare Part B, and a written physician order must be on file before the device is dispensed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CMS discontinued Certificates of Medical Necessity in January 2023, so the written order and the medical record now carry the coverage evidence.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Most denials trace back to two errors: billing L0622 for a prefabricated device, and leaving off the KX modifier.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps orders, fabrication records, and fitting notes in one client record, so claims go out complete.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code L0622 is a Level II code for a flexible, custom fabricated sacroiliac orthosis. It sits in the DMEPOS category, which covers durable medical equipment, prosthetics, orthotics, and supplies. The code is maintained by the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">Centers for Medicare and Medicaid Services (CMS)<\/a>. The full official descriptor reads:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Three clinical elements inside that descriptor decide when L0622 is the right code:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Flexible construction:<\/strong> The orthosis is built from flexible materials rather than rigid or semi-rigid panels. It compresses and stabilizes the pelvis and sacrum.<\/li>\n\n\n\n<li><strong>Pelvic-sacral support:<\/strong> The device reduces motion at the sacroiliac (SI) joint specifically, not at the lumbar spine.<\/li>\n\n\n\n<li><strong>Custom fabricated:<\/strong> The orthosis is made for one patient from measurements, a cast, or a digital scan. Off-the-shelf and prefabricated devices cannot be billed under L0622.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The phrase &#8220;may include pendulous abdomen design&#8221; means an abdominal panel extension is part of the same device. It does not need a separate code when it is built into the custom fabrication.<\/p>\n\n\n\n<h2 id=\"h-l0622-code-details-at-a-glance\" class=\"wp-block-heading\">L0622 code details at a glance<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Use the quick-reference table below to confirm the code&#8217;s classification before billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">L0622<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code system<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">L-codes (orthotic procedures)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Device type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacroiliac orthosis (SO), flexible<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fabrication<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Custom fabricated, not prefabricated<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Payer category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DMEPOS (Medicare Part B)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical biller<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DME supplier, orthotist, orthotic provider<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Written order required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, before dispensing (CGS Medicare policy)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-clinical-indications-and-medical-necessity\" class=\"wp-block-heading\">Clinical indications and medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare covers L0622 only when the record shows documented medical necessity. Coverage sits with each Medicare Administrative Contractor (MAC) and its Local Coverage Determination (LCD). Check the LCD that applies in the patient&#8217;s state, because the criteria are not identical everywhere.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Qualifying conditions usually include sacroiliac joint dysfunction, SI joint pain confirmed on examination or imaging, and pelvic girdle instability. Orthotic providers who take referrals from <a href=\"https:\/\/pabau.com\/industry\/chiropractic-software\/\">chiropractic practices<\/a> and <a href=\"https:\/\/pabau.com\/industry\/pelvic-health-software\/\">pelvic health practices<\/a> should check that the referring notes spell out functional limitation. The conservative treatment history has to be there too.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis alone never carries the claim. A patient can have textbook SI joint pathology and still see the claim denied if the notes stop at the diagnosis line.<\/p>\n\n\n\n<h3 id=\"h-factors-that-support-medical-necessity\" class=\"wp-block-heading\">Factors that support medical necessity<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinical documentation of SI joint pain or instability, with its effect on mobility or daily activities<\/li>\n\n\n\n<li>Conservative treatment history, such as physical therapy or anti-inflammatory medication, that has not given enough relief<\/li>\n\n\n\n<li>The treating physician&#8217;s assessment that pelvic-sacral support is clinically indicated<\/li>\n\n\n\n<li>Physical examination findings, such as a positive FABER or FADIR test, or SI joint provocation tests<\/li>\n\n\n\n<li>Imaging findings from X-ray, MRI, or CT that support SI joint pathology, where imaging exists<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Custom fabrication adds a second necessity test. The record has to explain why a prefabricated device will not work for this patient&#8217;s anatomy or presentation. Write that down before fabrication starts, not after the claim is denied.<\/p>\n\n\n\n<h2 id=\"h-medicare-coverage-and-2026-fee-schedule-for-l0622\" class=\"wp-block-heading\">Medicare coverage and 2026 fee schedule for L0622<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">L0622 is covered under Medicare Part B as a DMEPOS benefit. Two conditions apply: the medical necessity criteria are met, and the supplier is enrolled in the DMEPOS supplier program. The <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup tool<\/a> and the annual DMEPOS fee schedule are the authoritative sources for current rates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">DMEPOS fee schedules are updated every year and vary by MAC locality. Verify the amount against the current CMS schedule at the time of billing. Custom fabricated orthoses pay more than their prefabricated equivalents, which reflects the clinical labor in fabrication, fitting, and adjustment.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Coverage element<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare benefit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Part B DMEPOS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Supplier enrollment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DMEPOS supplier number required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Assignment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Assignment accepted; patient pays 20% coinsurance after the deductible<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fee schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS DMEPOS fee schedule, updated annually and locality-based<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LCD authority<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The applicable MAC&#8217;s LCD governs coverage criteria<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required when LCD criteria are met and documented<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Check the current L0622 rate on the CMS DMEPOS fee schedule before you quote a patient. Rates vary by MAC locality and change every January. An outdated quote creates a billing discrepancy and a difficult conversation later.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-documentation-requirements-for-billing-l0622\" class=\"wp-block-heading\">Documentation requirements for billing L0622<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Missing documentation causes more L0622 denials than any other single issue. Under CGS Medicare Jurisdiction C policy, the treating physician&#8217;s written order has to be obtained before the device is dispensed. Billing without a valid written order is a compliance failure, whatever the clinical picture looks like.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that run on <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">structured medical forms<\/a> capture this paperwork at the point of care instead of chasing it before submission. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake forms<\/a> that file the signed order into the patient record the moment it is signed remove the most common pre-billing problem.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-l0622\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s consent and intake forms can be built around the L0622 order, so the signed document lands in the patient record immediately.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Storage matters as much as capture. Keep the custom fabrication rationale, the fitting notes, and the physician order somewhere retrievable for audit, and keep <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant records<\/a> throughout. A referral that arrives without a clear necessity statement is easier to fix with a <a href=\"https:\/\/pabau.com\/templates\/medical-necessity-letter\/\">medical necessity letter<\/a> than with an appeal.<\/p>\n\n\n\n<h3 id=\"h-required-documentation-checklist-for-l0622\" class=\"wp-block-heading\">Required documentation checklist for L0622<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Written physician order:<\/strong> Signed by the treating physician before dispensing, naming the orthosis type and the clinical indication<\/li>\n\n\n\n<li><strong>Clinical notes supporting medical necessity:<\/strong> Examination findings, functional limitations, diagnostic results, and treatment history from the referring provider<\/li>\n\n\n\n<li><strong>Custom fabrication rationale:<\/strong> A written explanation of why a prefabricated device is not appropriate for this patient<\/li>\n\n\n\n<li><strong>Fabrication records:<\/strong> The measurements, cast, or digital scan used to build the device<\/li>\n\n\n\n<li><strong>Fitting and delivery records:<\/strong> Delivery date, patient signature confirming receipt, and fitting notes<\/li>\n\n\n\n<li><strong>No Certificate of Medical Necessity:<\/strong> CMS discontinued CMN forms and DME information forms for dates of service on or after January 1, 2023. The standard written order and the medical record carry that evidence now<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-to-bill-l0622-correctly\" class=\"wp-block-heading\">How to bill L0622 correctly<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Picking the right code is only the first step in an L0622 claim. Modifier use, place of service, and supplier enrollment all decide whether it pays on first submission. A <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management platform<\/a> that understands DMEPOS rules takes most of the manual checking off your team.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-l0622\/automate-claims-through-healthcode.webp\" alt=\"Automated claims and billing in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau builds the claim from the treatment record, so the L0622 line item carries the codes and modifiers your team already entered.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 id=\"h-modifier-guide-for-l0622\" class=\"wp-block-heading\">Modifier guide for L0622<\/h3>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Risk if omitted<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LCD criteria are met and the documentation is on file<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Claim denied, and may be read as non-covered<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">An ABN is on file, so a denied claim can still be billed to the patient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supplier cannot collect from the patient if the claim is denied<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The item is statutorily non-covered or not a Medicare benefit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incorrect billing; do not use GY where coverage may exist<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier rules for DMEPOS items are MAC-specific, so confirm them before you submit. The <a href=\"https:\/\/www.cgsmedicare.com\/jc\/pubs\/news\/2026\/02\/cope195587.html\" target=\"_blank\" rel=\"nofollow noopener\">CGS Medicare coding verification process<\/a> sets out PDAC guidance for suppliers who need to confirm product coding before dispensing. <a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">Automated billing workflows<\/a> can flag a missing modifier before submission rather than at remittance.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-l0622\/automated-communication-in-pabau.webp\" alt=\"Automated communication in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated messages chase the referring physician for a missing order, so the device is not dispensed ahead of the paperwork.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 id=\"h-place-of-service-and-supplier-requirements\" class=\"wp-block-heading\">Place of service and supplier requirements<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The supplier must hold an active DMEPOS supplier number from the National Supplier Clearinghouse (NSC)<\/li>\n\n\n\n<li>Place of service code 12 (home) is common for DMEPOS deliveries; confirm with the MAC for orthoses dispensed in a facility<\/li>\n\n\n\n<li>Accreditation from a CMS-approved DMEPOS accreditation organization is required for most suppliers<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">None of this is unique to orthoses. Suppliers billing other DMEPOS items, such as <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-e0371\/\">E0371<\/a> or <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-k0455\/\">K0455<\/a>, work to the same enrollment and order rules.<\/p>\n\n\n\n<h2 id=\"h-custom-vs-prefabricated-sacroiliac-orthoses-coding-the-difference\" class=\"wp-block-heading\">Custom vs. prefabricated sacroiliac orthoses: Coding the difference<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Billing L0622 for a device that is actually prefabricated is a compliance risk. CMS defines custom fabricated as built from raw materials or components for one patient. The measurements, cast, or digital scan come from the treating provider. A stock brace adjusted at the fitting is a different thing entirely.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Characteristic<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Custom fabricated (L0622)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Prefabricated (L0621)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fabrication method<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Made from raw materials for one patient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Manufactured in standard sizes, fitted at dispensing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Patient measurements<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required: a cast, scan, or detailed measurements<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not required beyond size selection<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Reimbursement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher, reflecting fabrication labor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Documentation burden<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher, because fabrication records are required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard medical necessity documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Audit risk if miscoded<\/td>\n<td style=\"padding:12px 16px;color:#374151\">High, if L0622 is billed for a prefabricated device<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower, assuming the correct code is selected<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Keep the fabrication record, including the method used, in the patient file. Audit reviewers look for that evidence first whenever L0622 appears on a claim. A <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">patient record system<\/a> that timestamps entries and stores fitting records beside the physician order makes an audit far less painful.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-l0622\/comprehensive-emr-patient-record-management.webp\" alt=\"Comprehensive EMR and patient record management\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s client record holds the order, the fabrication measurements, and the fitting notes together, which is exactly what an L0622 audit asks for.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-related-hcpcs-codes-l0621-l0623-and-l0624\" class=\"wp-block-heading\">Related HCPCS codes: L0621, L0623, and L0624<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The sacroiliac orthosis family runs from L0621 to L0624 and covers two design types across two fabrication methods. Match the device you actually dispensed to the descriptor, rather than defaulting to the code that pays best. The <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS code lookup<\/a> is a searchable reference for the full L-code range.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key differentiator<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L0621<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacroiliac orthosis, flexible, prefabricated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Off-the-shelf, with no fabrication required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L0622<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacroiliac orthosis, flexible, custom fabricated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Made to patient measurements, higher reimbursement<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L0623<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacroiliac orthosis, semi-rigid, prefabricated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rigid or semi-rigid panels, prefabricated<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L0624<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacroiliac orthosis, semi-rigid, custom fabricated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rigid or semi-rigid panels, built for one patient<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Flexible versus semi-rigid refers to the primary structural material of the orthosis, not to optional add-ons. Billing a semi-rigid device under L0622 is a coding error. Codes above L0624, including <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-l0625\/\">L0625<\/a>, are lumbar orthoses rather than sacroiliac ones, so they never stand in for L0622.<\/p>\n\n\n\n<h2 id=\"h-icd-10-codes-commonly-paired-with-l0622\" class=\"wp-block-heading\">ICD-10 codes commonly paired with L0622<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis submitted with L0622 has to support what the device does: stabilize the sacroiliac joint and reduce pelvic motion. Mismatched diagnosis codes trigger medical necessity denials even when the device itself qualifies, so audit your pairings regularly.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M53.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sacrococcygeal disorders, not elsewhere classified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary code for SI joint and sacrococcygeal dysfunction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M47.816<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Spondylosis without myelopathy or radiculopathy, lumbar region<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used when lumbar spondylosis adds stress to the SI joint<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M43.16<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Spondylolisthesis, lumbar region<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Instability patterns affecting the pelvic girdle<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">O26.719<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subluxation of symphysis pubis in pregnancy, unspecified trimester<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pelvic instability in pregnancy; use O26.72 or O26.73 after delivery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M54.50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Low back pain, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use with caution; payers usually want an SI-specific diagnosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two details catch coders out here. M54.5 was retired effective October 1, 2021, and replaced by M54.50, M54.51, and M54.59, so the old code now generates an edit. O26.7 is a parent code that needs a further character, which is why the table above uses O26.719.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">More importantly, most MACs want a diagnosis specific to sacroiliac pathology before they approve an SI orthosis. A nonspecific low back pain code rarely carries the claim on its own.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-denial-reasons\" class=\"wp-block-heading\">Common billing errors and denial reasons<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A run of L0622 denials at one supplier usually comes back to the same short list of errors. Name them once, build a pre-submission check, and the rework stops. A <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management platform<\/a> that flags claim-level problems before submission catches most of them early.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>No written order before dispensing:<\/strong> The order has to precede dispensing, and a retroactive order does not satisfy Medicare policy. Fix: hold dispensing until the signed order is in the patient record.<\/li>\n\n\n\n<li><strong>Billing L0622 for a prefabricated device:<\/strong> A stock brace adjusted at the fitting is not custom fabricated. Fix: confirm the fabrication method at intake and route the claim to L0621 where it belongs.<\/li>\n\n\n\n<li><strong>Missing KX modifier:<\/strong> The claim goes out without KX even though the LCD criteria are met and documented. Fix: make the KX check a standard step for every DMEPOS orthotic claim.<\/li>\n\n\n\n<li><strong>Thin medical necessity documentation:<\/strong> Physician notes that record a diagnosis but not the functional limitation or the conservative treatment history. Fix: use a referral form that prompts for each required element.<\/li>\n\n\n\n<li><strong>Mismatched ICD-10 code:<\/strong> A nonspecific low back pain diagnosis submitted with an SI-specific orthosis. Fix: confirm the diagnosis supports SI joint pathology before submitting.<\/li>\n\n\n\n<li><strong>Lapsed DMEPOS accreditation:<\/strong> Claims submitted under a supplier number whose accreditation has expired. Fix: calendar the renewal date and set reminders 90 and 30 days out.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a five-point check on every L0622 claim before it goes out. Is the written order dated before dispensing? Does the code match the device type? Is the KX modifier applied? Are the fabrication records on file, and does the diagnosis match SI joint pathology? The check takes two minutes and catches most denial triggers.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-supports-dme-and-orthotic-billing-documentation\" class=\"wp-block-heading\">How Pabau supports DME and orthotic billing documentation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most supply operations, the L0622 paper trail lives in three places at once. The physician order sits in an email inbox. The measurements stay in a workshop folder. The fitting notes are on paper at the front desk, and none of it is attached to the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps all of it in one client record. Digital intake and consent forms capture the signed order at the point of care, and every entry is timestamped as it is added. When a reviewer asks for proof, your team opens one file instead of chasing three.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For groups billing DMEPOS across several sites, the same form templates apply everywhere. Billing staff can see whether the order, the fabrication record, and the diagnosis are all present before a claim leaves the building. Fewer claims come back for rework, and an audit request stops being a scramble.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Stop losing L0622 claims to missing paperwork                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps physician orders, custom fabrication records, and medical necessity notes in one client record. Claims go out complete, and audit requests take minutes instead of days.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard for DME billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">L0622 pays reliably when the device and the record agree with each other. The fabrication has to be genuine, documented, and ordered in writing before the device goes out. Almost everything else on the claim follows from that one sequence.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The neighboring codes are close enough to catch people out. A semi-rigid device belongs in L0623 or L0624, and a stock brace belongs in L0621. Check the device in front of you rather than the code you billed last time.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fix the record and the denials mostly take care of themselves. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps orthotic orders, fabrication records, and claims in one place.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another sacral-region device?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4290\/\">A4290<\/a> covers the sacral nerve stimulation test lead, with its own coverage and documentation rules.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Supplying other Medicare DMEPOS items?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-e0302\/\">E0302<\/a> walks through the written order and medical necessity rules for a bariatric hospital bed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding lumbar spine procedures too?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-22527\/\">22527<\/a> explains how percutaneous intradiscal annuloplasty is documented and billed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a cleaner handover at discharge?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/patient-discharge-form\/\">Patient discharge form<\/a> gives you a template covering instructions, follow-up, and patient acknowledgment.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Documenting a lumbar surgical case?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-22102\/\">22102<\/a> sets out the coding and operative note detail payers expect.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786693199552\"><h3 class=\"schema-faq-question\">What is HCPCS code L0622?<\/h3> <p class=\"schema-faq-answer\">HCPCS code L0622 is a Level II DMEPOS code for a flexible, custom fabricated sacroiliac orthosis. The device gives pelvic-sacral support, reduces motion at the SI joint, and includes straps and closures. It may also include a pendulous abdomen design. Bill it under Medicare Part B when the necessity criteria are met and a written physician order is on file.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693199553\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for L0622?<\/h3> <p class=\"schema-faq-answer\">The rate is set by the annual CMS DMEPOS fee schedule and varies by MAC locality. Rates change each January, so verify the amount on the current schedule before you quote a patient. Custom fabricated orthoses pay more than prefabricated equivalents because of the fabrication and fitting labor involved.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693199554\"><h3 class=\"schema-faq-question\">What documentation is required to bill L0622?<\/h3> <p class=\"schema-faq-answer\">You need a written physician order signed before dispensing, plus clinical notes covering examination findings, functional limitations, and treatment history. Add the custom fabrication rationale, the fabrication records, and the fitting and delivery records with the patient&#8217;s signature. CMS discontinued Certificates of Medical Necessity for dates of service on or after January 1, 2023. The written order and the medical record carry that evidence now.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693199555\"><h3 class=\"schema-faq-question\">What is the difference between L0621 and L0622?<\/h3> <p class=\"schema-faq-answer\">L0621 is the prefabricated version of the flexible sacroiliac orthosis, made in standard sizes and fitted at dispensing. L0622 is the custom fabricated equivalent, built for one patient from measurements, a cast, or a digital scan. L0622 reimburses higher and needs fabrication documentation that L0621 does not.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693199556\"><h3 class=\"schema-faq-question\">Can L0622 be billed without a physician order?<\/h3> <p class=\"schema-faq-answer\">No. Under CGS Medicare Jurisdiction C policy, the treating physician&#8217;s written order must be obtained before the device is dispensed. Billing L0622 without one is a compliance violation, and a retroactive order does not fix it. The order must be dated before the date of service on the claim.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693199557\"><h3 class=\"schema-faq-question\">What conditions qualify for L0622?<\/h3> <p class=\"schema-faq-answer\">Qualifying conditions usually include sacroiliac joint dysfunction, SI joint pain with documented functional limitation, and pelvic girdle instability. Coverage follows the applicable MAC&#8217;s LCD, so accepted diagnoses vary by jurisdiction. M53.3 is the most commonly paired diagnosis, and nonspecific low back pain codes alone rarely satisfy payer criteria.<\/p> <\/div><\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code L0622 is a Level II code for a flexible, custom fabricated sacroiliac orthosis. It sits in the DMEPOS category, which covers durable medical equipment, prosthetics, orthotics, and supplies. The code is maintained by the Centers for Medicare and Medicaid Services (CMS). The full official descriptor reads: Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":180111,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"89","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548,1125],"tags":[1606,3211,1582,3471],"class_list":["post-180112","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","category-musculoskeletal-pain-management","tag-dme-billing","tag-dme-supplier","tag-hcpcs","tag-medicare-dme-coverage"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code L0622: Coverage, modifiers and denial fixes<\/title>\n<meta name=\"description\" content=\"L0622 covers a custom fabricated flexible sacroiliac orthosis. 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Bill it with a written order, KX modifier and fabrication records.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-l0622\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-14T08:46:13+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-14T10:53:50+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-l0622.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"HCPCS code L0622: Sacroiliac orthosis, custom fabricated\",\"datePublished\":\"2026-08-14T08:46:13+00:00\",\"dateModified\":\"2026-08-14T10:53:50+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/\"},\"wordCount\":2629,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-l0622.webp\",\"keywords\":[\"Dme Billing\",\"Dme supplier\",\"Hcpcs\",\"Medicare dme coverage\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\",\"Musculoskeletal &amp; Pain Management\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/\",\"name\":\"HCPCS code L0622: Coverage, modifiers and denial fixes\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-l0622\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-l0622.webp\",\"datePublished\":\"2026-08-14T08:46:13+00:00\",\"dateModified\":\"2026-08-14T10:53:50+00:00\",\"description\":\"L0622 covers a custom fabricated flexible sacroiliac orthosis. 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