Brace Align GlideFit SI Belt - PDAC Approved
PDAC Approval Information:
- Product Name: Brace Align GlideFit SI Belt
- Document Control Number (DCN): 25206047000000
- Effective Date: 2025-09-23
- Download Official PDAC Approval Letter (PDF)
This assignment of HCPCS codes does not imply Medicare endorsement nor guarantee reimbursement or coverage.
HCPCS Code: L0621 Model Number: BKB420XX
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