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HCPCS L0622 Fee Schedule

Last Verified: November 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
Key FactDetail
Service Type

Orthotic Procedures and services

Sacral Orthotics

Complexity LevelModerate

National average reimbursement for HCPCS L0622 by major payers:

bcbs

$276.76

uhc

$173.70

aetna

$183.30

cigna

$250.59

Preview provider-level rates for...
For billing codeHCPCS L0622
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS L0622

United
L0622$146.741417979501 - JEFFERSON KILPATRICK455568773NCFacial Plastic Surgery Physician (207YS0123X)
United
L0622$145.191013553197 - AMY MOORE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALAcute Care Nurse Practitioner (363LA2100X)
United
L0622$143.071851400485 - GEORGE HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
L0622$143.071851400485 - GEORGE HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
L0622$143.071851400485 - GEORGE HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
L0622$145.191679845531 - DANA HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
L0622$145.191790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
L0622$145.191851400485 - GEORGE HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
L0622$145.191417979501 - JEFFERSON KILPATRICK560942061 - (NC) PINEHURST SURGICAL CLINIC, P.A.NCFacial Plastic Surgery Physician (207YS0123X)
United
L0622$146.741417979501 - JEFFERSON KILPATRICK455568773NCFacial Plastic Surgery Physician (207YS0123X)
United
L0622$96.801548859895 - ALICIA ENCINAS300394179 - (AZ) MIGUEL A ARENAS MD PCCAFamily Nurse Practitioner (363LF0000X)
United
L0622$146.111629185285 - BACON COUNTY HEALTH SERVICES, INC.582224545 - (GA) BACON COUNTY HEALTH SERVICES INCGACritical Access Hospital (282NC0060X)
United
L0622$145.191548859895 - ALICIA ENCINAS300394179 - (AZ) MIGUEL A ARENAS MD PCCAFamily Nurse Practitioner (363LF0000X)
United
L0622$96.801952776023 - KRISTINA JIMENEZ300394179 - (AZ) MIGUEL A ARENAS MD PCAZFamily Nurse Practitioner (363LF0000X)
United
L0622$198.101962462226 - TIFT REGIONAL HEALTH SYSTEM INC., TIFT REGIONAL MEDICAL CENTER453072990 - (GA) TIFT REGIONAL HEALTH SYSTEM INCGAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS L0622 vs. Other Sacral Orthotics Codes

The HCPCS L0622 code is part of the Orthotic Procedures and services services used for Sacral Orthotics. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS L0622 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
L0621-HCPCSLowSacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
L0622-HCPCSModerateSacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
L0623-HCPCSLowSacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L0622. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the L0622 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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