L0639 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for ~Lso s/c shell/panel prefab.
National Average Payment
National Medicare Payment
$1,452.83
This fee schedule does not publish separate facility and non-facility rates for this code.
Effective Q3 2026
National Medicare payment
The amounts shown are the published national payments. Local payment can vary based on your specific Zip Code, GPCI adjustments, and site of service.
Rates vary by location
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Historical Medicare Reimbursement
| Quarter | National Medicare Payment | YoY % Change |
|---|---|---|
| 2026 Q3 | $1,452.83 | +2.00% |
| 2026 Q2 | $1,452.83 | +2.00% |
| 2026 Q1 | $1,457.75 | +2.35% |
| 2025 Q4 | $1,424.34 | — |
| 2025 Q3 | $1,424.34 | — |
| 2025 Q2 | $1,424.34 | — |
| 2025 Q1 | $1,424.34 | — |
Code Description
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
Reimbursement Summary
CPT code L0639 (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) had a 2026 Medicare non-facility reimbursement rate of $1,452.83. This reflects a 2.00% change from the prior year.
The 2026 National Medicare reimbursement estimate for L0639 is $1,452.83. Actual payment can vary by locality, setting, and claim specifics.
Description: Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from.... For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
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 L0639 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
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 L0639?
The 2026 National Average Medicare reimbursement rate for L0639 (DMEPOS Equipment) is $1,452.83. This rate is effective as of January 1, 2026.
What is the description for code L0639?
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
Why do facility and non-facility payments differ for L0639?
Facility vs. non-facility differences usually apply to RVU-based physician services. L0639 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for L0639?
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 L0639 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.
