L0457
Prosthetics & Orthotics
53 States
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
Short Desc
Tlso flex trnk sj-ss pre ots
Coverage determined by local carrier discretion.
Added Date
2014-01-01
Effective From
2014-01-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,136.84
|
Same |
|
AL
|
Base Rate |
$772.46
|
$1,000.69
|
|
AR
|
Base Rate |
$772.46
|
$1,000.62
|
|
AZ
|
Base Rate |
$728.43
|
$982.72
|
|
CA
|
Base Rate |
$340.25
|
$982.72
|
|
CO
|
Base Rate |
$507.07
|
$1,004.08
|
|
CT
|
Base Rate |
$772.46
|
$982.72
|
|
DC
|
Base Rate |
$677.75
|
$982.72
|
|
DE
|
Base Rate |
$677.75
|
$982.72
|
|
FL
|
Base Rate |
$772.46
|
$1,000.69
|
|
GA
|
Base Rate |
$772.46
|
$1,000.69
|
|
HI
|
Base Rate |
$1,136.84
|
Same |
|
IA
|
Base Rate |
$757.32
|
$994.36
|
|
ID
|
Base Rate |
$507.07
|
$982.72
|
|
IL
|
Base Rate |
$655.74
|
$997.38
|
|
IN
|
Base Rate |
$655.74
|
$997.38
|
|
KS
|
Base Rate |
$757.32
|
$994.36
|
|
KY
|
Base Rate |
$772.46
|
$1,000.69
|
|
LA
|
Base Rate |
$772.46
|
$1,000.62
|
|
MA
|
Base Rate |
$772.46
|
$982.72
|
|
MD
|
Base Rate |
$677.75
|
$982.72
|
|
ME
|
Base Rate |
$772.46
|
$982.72
|
|
MI
|
Base Rate |
$655.74
|
$997.38
|
|
MN
|
Base Rate |
$757.32
|
$997.38
|
|
MO
|
Base Rate |
$757.32
|
$994.36
|
|
MS
|
Base Rate |
$772.46
|
$1,000.69
|
|
MT
|
Base Rate |
$507.07
|
$1,004.08
|
|
NC
|
Base Rate |
$772.46
|
$1,000.69
|
|
ND
|
Base Rate |
$757.32
|
$1,004.08
|
|
NE
|
Base Rate |
$757.32
|
$994.36
|
|
NH
|
Base Rate |
$772.46
|
$982.72
|
|
NJ
|
Base Rate |
$677.75
|
$982.72
|
|
NM
|
Base Rate |
$728.43
|
$1,000.62
|
|
NV
|
Base Rate |
$340.25
|
$982.72
|
|
NY
|
Base Rate |
$677.75
|
$982.72
|
|
OH
|
Base Rate |
$655.74
|
$997.38
|
|
OK
|
Base Rate |
$728.43
|
$1,000.62
|
|
OR
|
Base Rate |
$340.25
|
$982.72
|
|
PA
|
Base Rate |
$677.75
|
$982.72
|
|
PR
|
Base Rate |
$1,196.50
|
Same |
|
RI
|
Base Rate |
$772.46
|
$982.72
|
|
SC
|
Base Rate |
$772.46
|
$1,000.69
|
|
SD
|
Base Rate |
$757.32
|
$1,004.08
|
|
TN
|
Base Rate |
$772.46
|
$1,000.69
|
|
TX
|
Base Rate |
$728.43
|
$1,000.62
|
|
UT
|
Base Rate |
$507.07
|
$1,004.08
|
|
VA
|
Base Rate |
$772.46
|
$982.72
|
|
VI
|
Base Rate |
$1,196.50
|
Same |
|
VT
|
Base Rate |
$772.46
|
$982.72
|
|
WA
|
Base Rate |
$340.25
|
$982.72
|
|
WI
|
Base Rate |
$655.74
|
$997.38
|
|
WV
|
Base Rate |
$772.46
|
$982.72
|
|
WY
|
Base Rate |
$507.07
|
$1,004.08
|