Browse HCPCS Level II 2020 Edition

L1200 - L1290  Scoliosis - Thoracic-Lumbar-Sacral Orthotic (Low Profile)

L1200 Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only short Furnsh initial orthosis only MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 2 Date of Service Edit: Policy Anatomic Consideration DME 1.0 2 Date of Service Edit: Policy Anatomic Consideration

L1210 Addition to tlso, (low profile), lateral thoracic extension short Lateral thoracic extension MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Nature of Equipment DME 2.0 3 Date of Service Edit: Clinical Nature of Equipment

L1220 Addition to tlso, (low profile), anterior thoracic extension short Anterior thoracic extension MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Nature of Equipment DME 1.0 3 Date of Service Edit: Clinical Nature of Equipment

L1230 Addition to tlso, (low profile), milwaukee type superstructure short Milwaukee type superstructur MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 2 Date of Service Edit: Policy Nature of Equipment DME 1.0 2 Date of Service Edit: Policy Nature of Equipment

L1240 Addition to tlso, (low profile), lumbar derotation pad short Lumbar derotation pad MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Nature of Equipment DME 1.0 3 Date of Service Edit: Clinical Nature of Equipment

L1250 Addition to tlso, (low profile), anterior asis pad short Anterior asis pad MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Nature of Equipment DME 2.0 3 Date of Service Edit: Clinical Nature of Equipment

L1260 Addition to tlso, (low profile), anterior thoracic derotation pad short Anterior thoracic derotation MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Nature of Equipment DME 1.0 3 Date of Service Edit: Clinical Nature of Equipment

L1270 Addition to tlso, (low profile), abdominal pad short Abdominal pad MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 3.0 3 Date of Service Edit: Clinical Nature of Equipment DME 3.0 3 Date of Service Edit: Clinical Nature of Equipment

L1280 Addition to tlso, (low profile), rib gusset (elastic), each short Rib gusset (elastic) each MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Nature of Equipment DME 2.0 3 Date of Service Edit: Clinical Nature of Equipment

L1290 Addition to tlso, (low profile), lateral trochanteric pad short Lateral trochanteric pad MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Nature of Equipment DME 2.0 3 Date of Service Edit: Clinical Nature of Equipment