## **What is the HCPCS code L0174 for?**
The HCPCS code L0174 is meant to designate the provision of a semi-rigid cervical collar that has thermoplastic foam in the anterior and posterior panels that extends support from the cervical spine region to the upper thoracic spine region (innovative height adjustment technology).
This orthosis immobilizes the cervical spine (and the upper thoracic spine if the extension is utilized), and by immobilizing it, it can manage neck pain, promote healing, and prevent further injury. It is also prefabricated and off-the-shelf, meaning it can be obtained and fitted immediately, but this means there are no customizations specific to the patient's needs beyond what the orthosis can provide.
This is often provided to patients with the following problems:
- Cervical spine sprains
- Cervical spine fractures
- Cervical spondylosis
- Cervical spine stenosis
- Recovery after spinal surgery
## **Documentation requirements for L1074**
Before filing claims for L1074, please make sure you have sufficient documentation that follows proper coding guidelines, such as the following:
- The full name of the patient receiving the orthosis
- The full name and credentials of the healthcare providers involved in assessing the patient, and the fitting and customization of the orthosis
- The patient's medical history and any relevant clinical indications and diagnoses to justify the medical necessity of the orthosis
- Documentation that supports any adjustments made, and a certified orthotist should have done them, or a similarly trained professional at the time of delivery
- Documentation of a face-to-face evaluation and the fitting session to ensure that the orthosis is the correct size for the patient
- Please specify the product model and that it is included in the PDAC DMECS list. This requires a coding verification before billing
- Standard written order (SWO) or written order prior to delivery (WOPD), proof of delivery, and inventory costs (if any)
- Imaging tests showing the cervical spine and upper thoracic spine's condition
## **Billing requirements for L1074**
Besides the documentation requirements above, please make sure to take note of or have the following:
- Use the appropriate ICD code for your patient
- Use the KX modifier if all clinical and documentation requirements are met. If criteria are not fully met but an Advance Beneficiary Notice (ABN) is signed, use GA; if no ABN is in place, use GZ
- Double-check if this code requires a written coding verification review
- Proof of delivery, prior authorization, and supplier records
Please follow proper CMS/Medicare/relevant guidelines to avoid claim rejections.
## **Other similar codes**
- L0172 - Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
- L0120 - Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
- L0130 - Cervical, flexible, thermoplastic collar, molded to patient
- L0140 - Cervical, semi-rigid, adjustable (plastic collar)
- L0170 - Cervical, collar, molded to patient model
Frequently asked questions
