A lumbar sacral orthosis (LSO) can currently range in price from $70 to $ 1013.00
We realize that you might have come here for an exact price. As much as we want to give you one price, it is just not possible to do so. You will soon see why that is the case. Just know, that in this article we will give you a lot of good information and get you close when pricing out some different options.
If you go online right now, you can find a new LSO brace for $70.00, before shipping and tax. With this purchase you can expect a prefabricated LSO, a pamphlet of written instructions and a brace that will need to customized to your circumferences when it arrives by you or someone you know. If everything goes right, you could find that you got some needed support and you also saved some cash.
These all sound like good things to most of us. Saving cash is often times a good thing! However, it is important to keep in mind that you are talking about your spine. If you have a serious injury in your back such as an L4 compression fracture, or an L5 stress fracture, are you going to feel comfortable with the brace you just bought off the internet? This is kind of a big deal.
The possible downside here is that you might not be getting the support you need. Something is better than nothing, but there is always the “what if” factor. – For example, are you going to wonder in the back of your mind if you (and your fracture) could have done better? It is just a question that needs to come up because there are consequences to this approach. In the end it is truly up to you to decide, we are just trying to show both sides of the coin here.
Please do not get us wrong. We are not saying that internet LSOs are without value. That is not the case. It could be just what you need, or the situation could go bad. It is definitely a two way street. Please also read our other blogs on this site that talk about Common Problems With Back Braces & The Solutions To These Issues. It can be of great value to many people who use these braces in the application process.
From a cash standpoint, you are going to be asked to pay on the low end $70.00, plus shipping and taxes as mentioned earlier. This is our lower end estimation that we could find online. If you get a brace of this kind from a medical professional you can already assume that the price is going to be higher. If you assumed that to be true you are correct. But that price is before your insurance or Medicare could kicks in. We have seen braces get totally paid for by insurance and we have seen the exact opposite.
Medical professionals, at the time of this writing commonly use 3 base codes to bill a medical grade LSO to your insurance. Those codes are L0631, L0637, L0638. Each has a price attached to it that was not created by the medical professional giving you the brace.
Since you now know that the medical professional does not make up the price, this can hopefully give you some peace of mind. The two things are separated. That way the company providing it can not request a payment of $10,000.oo for the service. It is more regulated than that.
These hcpc codes (more specifically Lcodes, in this instance) can have a different dollar amount assigned to them. This dollar amount is dependent on the reimbursement allotted by your insurance / Medicare plan and/or subplans within a larger brand name. For example, XYZ insurance, “sunshine plan” reimbursement might be totally different than the reimbursement for the same brace for XYZ insurance “moonlight plan”. Even though XYZ insurance facilitates the plan, your requested payment amount could be very different within each subplan. Since your brace provider probably has a contract with XYZ then they are bound to charging you the price that is dictated by the insurance plan itself.
Having said that, the prices are usually close to each other, but they are still different. That is a big reason why we can not give you one price for each. Reimbursements for these codes can go up and down a little bit per region and per year, for example.
One insurance plan out there today (as of this writing) reimburses these codes at the following rates :
L0631 : $788.00 (prefab)
L0637 : $995.00 (prefab)
L0638 : $1013.00 (custom)
The picture here illustrates a custom LSO that is bivalve in design. Whereas the black one at the top of this blog post is a prefabricated design.
One form of coverage (I can not say who) may also decimate the coverage on L0631 and L0637 in the very near future and the service level to thousands of people will plummet. This is an unfortunate thing because hundreds of companies will need to cut medical trained and licensed staff all so money can be saved by a certain group. As a result, treatment will most likely be cut in all hospitals all across the country, which is a very unfortunate statement that we have to make. Especially since orthotists make up less than one half of one percent of the medical community already. (Hopefully we are wrong and this process never happens.)
Back to our story…
When it comes to insurance and Medicare etc there is a positive side and a potentially not so positive side, when it comes to money. If you have a higher end deductible, you may be a in a position that you may be asked to pay the difference on the LSO upfront. This is because some people take take the brace from a medical professional and then forget to answer the phone calls later when it comes to payment requests post-delivery. Money can be a struggle for many families for so many reasons and we get the “crunch” too.
If your deductible has not been met and you go to a medical office for the LSO, they may need to ask you for money upfront, or a portion of that with a payment plan as stated earlier. This is true whether you get a brace or you get another form of treatment elsewhere.
We always refer to a car shop comparison. When you take your car in to get service, you walk in usually with a certain set of expectations. Meaning, the car shop will fix my car and I will have trust that it was done right. And, I will not get my car back until I pay the bill. – In the medical field, this situation is flipped on its head even though the prices can often times be similar. People can walk in for treatment and then easily walk away when it comes time to pay on their bill. It’s a dilemma of sorts.
This is why so many places ask for a money commitment upfront if the deductible is not met. This is a not so positive side to the equation, if we look at it from the consumers point of view and the money that is owed. On the other side, the business has to ask for the payment or they obviously won’t be there in the future to service you again or other individuals who need help.
The positive side to it is you may be asked to pay nothing, if our deductible has been met, for example. That’s the power of insurance or Medicare plus a secondary insurance. It can go both ways.
Zero dollars is much less expensive than the $70.00 mark last time we checked. When you go to a medical professional (such as an orthotist) you also know that you are getting a medical grade brace with the absolute best instruction you can get both in written and verbal form. Also, with an orthotist (a licensed brace specialist) you can go back for adjustments and these are usually free of charge within a warranty period (check with your specific provider to confirm the details).
With a medical grade office, you are basically getting yourself into a scenario where you are getting the best brace you can, potentially paying nothing out of pocket and you are also buying a lot more trust.
Just like in the car example. You could fix the care yourself on the inexpensive side, but you know when you go to the mechanic that they give you a good running car back and the trust that goes along with that.
When it comes to your spine, trust matters. You might not need a ton of trust if you have a muscle ache that is only around sometimes. In this instance, if you choose to get a back brace for support from the internet you might be totally fine. But if the injury is significant then it’s best not to play around.
People’s legs can go numb due to back injuries that are significant, if left untreated, for example. While we are not promising that will happen you, you can hear what we are saying. The prefabricated LSOs mentioned earlier comprise the L0631 and L0637 codes and prices mentioned earlier. However, the L0638 base code is a code used for a custom-made LSOs. This is considered to be the top of the line when it comes to support. These back supports are made to an impression of your body and are custom made to that shape. Correction of the spine can be built into these back supports as well. They are typically more padded and are made of a more rigid material which helps if you have a real back injury.
That is the upside.
The downside is that the custom LSO needs to be made and although this process can be rushed, it typically takes at least 24 hours. This waiting period can be negated if you compare it to waiting period you will need to incur if you order a brace online anyways. Also, many orthotists have medical grade L0631s and L0637s on the shelf so you could get those immediately instead of having to wait for the mail to arrive. If you getting a custom LSO, you are looking at a higher dollar amount of approximately $ $1013.00 before consumable add on items such as body socks or additional pads that may be required.
Again, this could be covered by your insurance / Medicare or sometimes it is not. The brace company can help you figure that out. Moreover, if your deductible has been met then you might not owe anything. If it has not been met, you might owe the full amount. It just depends and the good part is that the orthotic company can tell you the numbers ahead of time as good as anyone can so you are aware of what is going on. They can tell you what the insurance company tells them. Nothing more.
You might see this in the fine print if you buy an LSO online and the seller does not want to adjust or take back your brace because it has “touched your skin”.
The upside to the internet is that the brace is probably as inexpensive as possible. However, instruction, quality, follow up and trust are probably not going to be as readily available to you. If you have a problem, the internet provider might not let you return it once the brace has touched your skin too or if it is has come out of the bag. Check with each of these providers online so you are aware of their policies if you do go this route.
We hope this information has helped you. Now, at least, you are much more equipped when it comes to knowing the ins and outs of the money equation when it comes to LSO braces for your spine. That part was free too! : )
*Rinella Prosthetics & Orthotics can not be responsible for any prices that you may incur if we are not involved in your treatment. We have best intentions when publishing this information but we can not control what other providers may or may not charge with respect to region or the add on codes that you may or may not need in your treatment. These costs are outpatient costs and may not reflect inpatient amounts.