HCPCS L0625 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Orthotic Procedures and services • Lumbar Orthotics |
| Complexity Level | Low |
National average reimbursement for HCPCS L0625 by major payers:
$32.26
$34.70
$33.16
$41.01
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L0625 | ||||||
United | L0625 | $79.97 | 1245809714 - BROOKE HENSCHEL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Single Specialty Group (193400000X) |
United | L0625 | $79.97 | 1801401252 - JODI TESCH | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | L0625 | $79.97 | 1114154192 - BENJAMIN SIEBERT | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Medicine & Rehabilitation Physician (208100000X) |
United | L0625 | $79.97 | 1154328896 - KELLEY PARNELL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurology Physician (2084N0400X) |
United | L0625 | $79.97 | 1578516803 - THE NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN SC, NEUROSCIENCE GROUP | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Multi-Specialty Group (193200000X) |
United | L0625 | $79.97 | 1104364637 - NICOLE GUTMAN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Family Nurse Practitioner (363LF0000X) |
United | L0625 | $79.97 | 1164862322 - BETHANY ROTHE | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Surgical Physician Assistant (363AS0400X) |
United | L0625 | $79.97 | 1235785478 - ARIENNE KRIZENESKY | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Family Nurse Practitioner (363LF0000X) |
United | L0625 | $79.97 | 1033523329 - DANIEL LONG | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurology Physician (2084N0400X) |
United | L0625 | $38.88 | 1447996863 - ALISON MARTIN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | L0625 | $79.97 | 1992286439 - RACHEL HAUGLY | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | L0625 | $79.97 | 1316231251 - NICOLE SHAFRAN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Speech-Language Pathologist (235Z00000X) |
United | L0625 | $79.97 | 1568605962 - JONATHAN HALL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | NY | Physical Medicine & Rehabilitation Physician (208100000X) |
United | L0625 | $79.97 | 1588941975 - BILLIE STURGEON | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | L0625 | $79.97 | 1093820219 - KIMBERLY KARRMANN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L0625 vs. Other Lumbar Orthotics Codes
The HCPCS L0625 code is part of the Orthotic Procedures and services services used for Lumbar 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 L0625 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.
| Code | Complexity | Description |
|---|---|---|
| L0624-HCPCS | Low | Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
| L0625-HCPCS | Low | Lumbar orthosis (LO), flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
| L0626-HCPCS | Low | Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), 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, 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L0625. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L0625 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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