# HCPCS L0621: Sacroiliac orthosis, flexible, provides pelvic-sacral support

Medicare HCPCS L0621 pays $71.18 on average under the 2026 Q4 Medicare DMEPOS Fee Schedule (non-rural). State amounts run from $33.70 in Washington to $127.41 in Hawaii, a 278% spread.

Web page: https://www.med-reveal.com/rates/L0621-hcpcs-fee-schedule
Section: DME, Prosthetics, Orthotics and Supplies

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $71.18 |
| National facility | $71.18 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Hawaii | $127.41 | $127.41 |
| Alaska | $122.63 | $122.63 |
| Puerto Rico | $109.65 | $109.65 |
| Virgin Islands | $109.08 | $109.08 |
| Alabama | $76.50 | $76.50 |
| Arkansas | $76.50 | $76.50 |
| Connecticut | $76.50 | $76.50 |
| Florida | $76.50 | $76.50 |
| Georgia | $76.50 | $76.50 |
| Kentucky | $76.50 | $76.50 |
| Louisiana | $76.50 | $76.50 |
| Maine | $76.50 | $76.50 |
| Massachusetts | $76.50 | $76.50 |
| Mississippi | $76.50 | $76.50 |
| New Hampshire | $76.50 | $76.50 |
| North Carolina | $76.50 | $76.50 |
| Rhode Island | $76.50 | $76.50 |
| South Carolina | $76.50 | $76.50 |
| Tennessee | $76.50 | $76.50 |
| Vermont | $76.50 | $76.50 |
| Virginia | $76.50 | $76.50 |
| West Virginia | $76.50 | $76.50 |
| Iowa | $75.00 | $75.00 |
| Kansas | $75.00 | $75.00 |
| Minnesota | $75.00 | $75.00 |
| Missouri | $75.00 | $75.00 |
| Nebraska | $75.00 | $75.00 |
| North Dakota | $75.00 | $75.00 |
| South Dakota | $75.00 | $75.00 |
| Arizona | $72.14 | $72.14 |
| New Mexico | $72.14 | $72.14 |
| Oklahoma | $72.14 | $72.14 |
| Texas | $72.14 | $72.14 |
| Delaware | $67.12 | $67.12 |
| District of Columbia | $67.12 | $67.12 |
| Maryland | $67.12 | $67.12 |
| New Jersey | $67.12 | $67.12 |
| New York | $67.12 | $67.12 |
| Pennsylvania | $67.12 | $67.12 |
| Illinois | $64.94 | $64.94 |
| Indiana | $64.94 | $64.94 |
| Michigan | $64.94 | $64.94 |
| Ohio | $64.94 | $64.94 |
| Wisconsin | $64.94 | $64.94 |
| Colorado | $50.21 | $50.21 |
| Idaho | $50.21 | $50.21 |
| Montana | $50.21 | $50.21 |
| Utah | $50.21 | $50.21 |
| Wyoming | $50.21 | $50.21 |
| California | $33.70 | $33.70 |
| Nevada | $33.70 | $33.70 |
| Oregon | $33.70 | $33.70 |
| Washington | $33.70 | $33.70 |

## Related codes

- L0112: Cranial cervical orthosis, congenital torticollis type — https://www.med-reveal.com/rates/L0112-hcpcs-fee-schedule
- L0140: Cervical, semi-rigid, thermoplastic collar, molded to patient — https://www.med-reveal.com/rates/L0140-hcpcs-fee-schedule
- L0450: Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support — https://www.med-reveal.com/rates/L0450-hcpcs-fee-schedule
- L0500: Thoracic-lumbar-sacral orthosis (TLSO), rigid, custom fitted — https://www.med-reveal.com/rates/L0500-hcpcs-fee-schedule
- L0630: Lumbar-sacral orthosis, sagittal control, rigid posterior panel — https://www.med-reveal.com/rates/L0630-hcpcs-fee-schedule
- L0810: Addition to halo procedure, cervical collar with attachment — https://www.med-reveal.com/rates/L0810-hcpcs-fee-schedule
- L1000: Cervical-thoracic-lumbar-sacral orthosis, anterior-posterior-lateral control — https://www.med-reveal.com/rates/L1000-hcpcs-fee-schedule
- L1685: Hip orthosis, abduction control of hip joints, dynamic — https://www.med-reveal.com/rates/L1685-hcpcs-fee-schedule

Commercial negotiated rates for L0621 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules