L0636 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for ~Lso sagittal rigid panel cus.
L0636 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $1,802.87 | $1,802.87 | $1,802.87 | $1,802.87 | $1,845.08 | $1,838.93 |
⚠️ This is a National Estimate
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Code Description
Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
Reimbursement Summary
CPT code L0636 (Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated) had a 2026 Medicare non-facility reimbursement rate of $1,838.93. This reflects a 2.00% change from the prior year.
The 2026 National Medicare reimbursement estimate for L0636 is $1,838.93. Actual payment can vary by locality, setting, and claim specifics.
Description: Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior .... For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
L0636 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $1,802.87 | $1,802.87 | $1,802.87 | $1,802.87 | $1,845.08 | $1,838.93 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $1,838.93 | $1,838.93 | +2.00% | +2.00% |
| 2026 Q1 | $1,845.08 | $1,845.08 | +2.34% | +2.34% |
| 2025 Q4 | $1,802.87 | $1,802.87 | — | — |
| 2025 Q3 | $1,802.87 | $1,802.87 | — | — |
| 2025 Q2 | $1,802.87 | $1,802.87 | — | — |
| 2025 Q1 | $1,802.87 | $1,802.87 | — | — |
Commercial Payer Rates for L0636
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For L0636 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for L0636?
The 2026 National Average Medicare reimbursement rate for L0636 (DMEPOS Equipment) is $1,838.93. This rate is effective as of January 1, 2026.
What is the description for code L0636?
Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
Why do facility and non-facility payments differ for L0636?
Facility vs. non-facility differences usually apply to RVU-based physician services. L0636 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for L0636?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is L0636 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
