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EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621
EXOS® FORM™ II 621

EXOS® FORM™ II 621

The EXOS FORM™ II 621 provides superior stabilization of the sacroiliac (SI) joint through direct compression. Silicone grip strips prevent the brace from migrating.

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HCPCS Code

L0621

Key Features
  • ComfortCORE™ Foam
    Conforms to the unique contours of a patient’s body, adjusts instantly to individual movements.
  • Diamond2 Grid™
    Uniquely designed construct, delivers patients’ a more durable, longer-wearing brace.
  • BOA® Fit System
    The micro-adjustable BOA® Fit System allows for a fast, effortless, precision fit through a customizable and seamless level of support.
  • Adjustable Belt Wings
    Modifiable belt accommodates varying patient body structures for optimal fit.
  • Modular Design
    Step-up / Step-down design allows for single brace use through rehabilitation and recovery.
  • Semi-Universal Sizing
    Removable circumference tape allows for accurate patient sizing.
Indications for Use
  • Sacroiliac pain
  • low back pain
  • low pack sprains/strains
Manufacturer
DJO
Manuf. Part No.
  • 300621-40
    S/M
  • 300621-60
    L/XL
Size Chart
Size Measurement
S/M 28 - 50 in (71 - 127 cm)
L/XL 51 - 61 in (130 - 155cm)

Call us to find out if you may qualify for a wrist product as a Medicare covered benefit.

866-712-0881

Medicare Beneficiary Eligibility Lookup

Enter your ZIP Code to determine if you are in a location where we provide bracing products as a Medicare covered benefit.

Because we instinctively put our hands out in front of us when we fall, we suffer wrist injuries more frequently than other types of injuries. Our wrists are designed to allow us liberal movement in many directions, and when you have a rupture, strain, sprain or fracture, this can be quite painful. A wrist brace immobilizes the wrist, allowing you to use your hand while limiting your range of motion to prevent pain.

As notorious as wrist injuries from accidents are, other conditions can cause chronic wrist pain, such as arthritis. Wearing a wrist brace can allow you to engage in more activities without pain, such as driving, writing, painting and playing cards.

Carpal tunnel syndrome is another reason for chronic wrist pain. Oftentimes limiting the activity that caused it — such as typing, playing an instrument and doing needlework — can improve your condition, and wearing a wrist brace in the meantime can help.

Contact us today for more information or to order your wrist brace.

Medicare Patients

Contact us with any questions about bracing or eligibility. We’ll make it easy for you. We'll even handle the paperwork should you qualify.

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Non-Medicare Patients

We are in-network with over 70 private insurance, workers’ compensation, and no-fault insurance companies.

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Providers

Send us a referral and we will make sure your patient receives the right brace – fast. Our staff of professionals are on-hand and ready to serve.

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