Mama Strut by PELV-ICE is a Class I medical device per the FDA under the categories:

  • Orthopedic and Surgical Supports
  • Joint Support Bandages

How to get reimbursed:

  • Contact your insurance provider for reimbursement forms or search their website for the list of eligible medical devices and online submission options.
  • Get your OBGYN or Midwife to write you a prescription with the coding below.
  • If you have a HSA or a FSA account attached to your insurance plan you can submit for reimbursement by completing their reimbursement form and attaching your proof of purchase or by purchasing with your HSA/FSA issued credit card. Some HSA/FSA cards accept our website and some do not. If yours is rejected on our site please call one of our pharmacy retailers listed here Store Locator

Sign-up below to be sent a printable prescription form for your doctor.

Prescription Request Form

Diagnosis Codes

Recommended ICD-10-CM codes:

  • R10.2  Pelvic and perineal pain
  • N81.2  Incomplete uterovaginal prolapse
  • N81.3   Complete uterovaginal prolapse
  • N81.81 Incomplete or weakening of pubocervical tissue
  • N81.82 Incomplete or weakening of rectovaginal tissue
  • O26.7   Subluxation of symphsis (pubis) in pregnancy, childbirth & puerperium
  • O71.89  Diastasis recti
  • K40-46 Hernia
  • O70.0-O70.4 Perineal laceration during delivery
  • M54.5  Acute or chronic pain in the lumbar or sacral region
  • M25.551/M25.552 Hip pain R/L
  • R10.30 Lower abdominal, inguinal, groin pain


HCPCS (product) Codes:

  • L8310 Pelvic Truss
  • L0621 Sacroiliac Orthosis, Flexible, Pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, fabricated, off-the-shelf
  • A9273 Hot water bottle, ice cap or collar, heat and or cold wrap any type