HCPCS Code L0622

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
Code effective Jan 01, 2006

HCPCS Section
Orthotic and Prosthetic Procedures, Devices

L0622 is a valid 2026 HCPCS code meaning Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated or (Sio flex pelvisacral custom) for short. HCPCS L0622 has been effective since 01/01/2006 and applies to Lump sum purchase of DME, prosthetics, orthotics.

HCPCS Code Details - L0622

HCPCS Level II Code
Section L - Orthotic and Prosthetic Procedures, Devices
HCPCS Code L0622
Description

Long description:
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

Short description:
Sio flex pelvisacral custom

HCPCS Pricing indicator 38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
BETOS2 code D1F - Prosthetic/Orthotic devices
HCPCS Action code N - No maintenance for this code
Type of service P - Lump sum purchase of DME, prosthetics, orthotics
Effective date Effective Jan 01, 2006
Date added Added Jan 01, 2006

See also

  • HCPCS L0621 · Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

  • HCPCS L0623 · Sacroiliac orthosis, 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

1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”

HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/23/2026

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.