HCPCS L0642

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

Current codeLumbar Sacral Orthosis Brace25 hospitals with prices

Description from CMS's HCPCS Level II code file.

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.

Prices for HCPCS L0642 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Olympic Medical CenterPort AngelesFile dated 2026-06-24	—	$167	$209
Swedish IssaquahIssaquahFile dated 2026-04-01	—	$654	$1,363
Swedish Medical CenterSeattleFile dated 2026-04-01	—	$654	$1,363
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01	—	$654	$1,363

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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: $141 (fee)