HCPCS L0633
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), 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, stays, shoulder straps, 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
Current codeLumbar Sacral Orthosis Brace24 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | $175 | $438 |
| Deaconess Medical Center | — | $175 | $438 |
| Harborview Medical Center | — | $421 | $602 |
| Mary Bridge Children's Hospital | — | $175 | $438 |
| MultiCare Auburn Medical Center | — | $175 | $438 |
| MultiCare Covington Medical Center | — | $175 | $438 |
| MultiCare Good Samaritan Hospital | — | $175 | $438 |
| MultiCare Valley Hospital | — | $175 | $438 |
| Seattle Children's Hospital | $458 – $580 | $1,783 | $1,783 |
| Tacoma General Allenmore Hospital | — | $175 | $438 |
| University of Washington Medical Ctr | — | $537 | $768 |
| Yakima Valley Memorial | — | $175 | $438 |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $344 (fee)