L0454
Prosthetics & Orthotics
53 States
Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Short Desc
Tlso trnk sj-t9 pre cst
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2014-01-01
National Floor
$380.76
National Ceiling
$507.68
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$416.01
|
Same |
|
AL
|
Base Rate |
$428.54
|
Same |
|
AR
|
Base Rate |
$428.50
|
Same |
|
AZ
|
Base Rate |
$416.01
|
Same |
|
CA
|
Base Rate |
$416.01
|
Same |
|
CO
|
Base Rate |
$430.89
|
Same |
|
CT
|
Base Rate |
$416.01
|
Same |
|
DC
|
Base Rate |
$416.01
|
Same |
|
DE
|
Base Rate |
$416.01
|
Same |
|
FL
|
Base Rate |
$428.54
|
Same |
|
GA
|
Base Rate |
$428.54
|
Same |
|
HI
|
Base Rate |
$416.01
|
Same |
|
IA
|
Base Rate |
$424.14
|
Same |
|
ID
|
Base Rate |
$416.01
|
Same |
|
IL
|
Base Rate |
$426.22
|
Same |
|
IN
|
Base Rate |
$426.22
|
Same |
|
KS
|
Base Rate |
$424.14
|
Same |
|
KY
|
Base Rate |
$428.54
|
Same |
|
LA
|
Base Rate |
$428.50
|
Same |
|
MA
|
Base Rate |
$416.01
|
Same |
|
MD
|
Base Rate |
$416.01
|
Same |
|
ME
|
Base Rate |
$416.01
|
Same |
|
MI
|
Base Rate |
$426.22
|
Same |
|
MN
|
Base Rate |
$426.22
|
Same |
|
MO
|
Base Rate |
$424.14
|
Same |
|
MS
|
Base Rate |
$428.54
|
Same |
|
MT
|
Base Rate |
$430.89
|
Same |
|
NC
|
Base Rate |
$428.54
|
Same |
|
ND
|
Base Rate |
$430.89
|
Same |
|
NE
|
Base Rate |
$424.14
|
Same |
|
NH
|
Base Rate |
$416.01
|
Same |
|
NJ
|
Base Rate |
$416.01
|
Same |
|
NM
|
Base Rate |
$428.50
|
Same |
|
NV
|
Base Rate |
$416.01
|
Same |
|
NY
|
Base Rate |
$416.01
|
Same |
|
OH
|
Base Rate |
$426.22
|
Same |
|
OK
|
Base Rate |
$428.50
|
Same |
|
OR
|
Base Rate |
$416.01
|
Same |
|
PA
|
Base Rate |
$416.01
|
Same |
|
PR
|
Base Rate |
$457.64
|
Same |
|
RI
|
Base Rate |
$416.01
|
Same |
|
SC
|
Base Rate |
$428.54
|
Same |
|
SD
|
Base Rate |
$430.89
|
Same |
|
TN
|
Base Rate |
$428.54
|
Same |
|
TX
|
Base Rate |
$428.50
|
Same |
|
UT
|
Base Rate |
$430.89
|
Same |
|
VA
|
Base Rate |
$416.01
|
Same |
|
VI
|
Base Rate |
$457.64
|
Same |
|
VT
|
Base Rate |
$416.01
|
Same |
|
WA
|
Base Rate |
$416.01
|
Same |
|
WI
|
Base Rate |
$426.22
|
Same |
|
WV
|
Base Rate |
$416.01
|
Same |
|
WY
|
Base Rate |
$430.89
|
Same |