L0469
Prosthetics & Orthotics
53 States
Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
Short Desc
Tlso rig fram pelvic 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 |
$602.56
|
Same |
|
AL
|
Base Rate |
$384.93
|
$488.53
|
|
AR
|
Base Rate |
$384.93
|
$477.22
|
|
AZ
|
Base Rate |
$362.99
|
$539.37
|
|
CA
|
Base Rate |
$169.55
|
$539.37
|
|
CO
|
Base Rate |
$252.68
|
$455.83
|
|
CT
|
Base Rate |
$384.93
|
$512.47
|
|
DC
|
Base Rate |
$337.73
|
$479.52
|
|
DE
|
Base Rate |
$337.73
|
$479.52
|
|
FL
|
Base Rate |
$384.93
|
$488.53
|
|
GA
|
Base Rate |
$384.93
|
$488.53
|
|
HI
|
Base Rate |
$625.66
|
Same |
|
IA
|
Base Rate |
$377.39
|
$477.26
|
|
ID
|
Base Rate |
$252.68
|
$517.83
|
|
IL
|
Base Rate |
$326.76
|
$484.63
|
|
IN
|
Base Rate |
$326.76
|
$484.63
|
|
KS
|
Base Rate |
$377.39
|
$477.26
|
|
KY
|
Base Rate |
$384.93
|
$488.53
|
|
LA
|
Base Rate |
$384.93
|
$477.22
|
|
MA
|
Base Rate |
$384.93
|
$512.47
|
|
MD
|
Base Rate |
$337.73
|
$479.52
|
|
ME
|
Base Rate |
$384.93
|
$512.47
|
|
MI
|
Base Rate |
$326.76
|
$484.63
|
|
MN
|
Base Rate |
$377.39
|
$484.63
|
|
MO
|
Base Rate |
$377.39
|
$477.26
|
|
MS
|
Base Rate |
$384.93
|
$488.53
|
|
MT
|
Base Rate |
$252.68
|
$455.83
|
|
NC
|
Base Rate |
$384.93
|
$488.53
|
|
ND
|
Base Rate |
$377.39
|
$455.83
|
|
NE
|
Base Rate |
$377.39
|
$477.26
|
|
NH
|
Base Rate |
$384.93
|
$512.47
|
|
NJ
|
Base Rate |
$337.73
|
$455.83
|
|
NM
|
Base Rate |
$362.99
|
$477.22
|
|
NV
|
Base Rate |
$169.55
|
$539.37
|
|
NY
|
Base Rate |
$337.73
|
$455.83
|
|
OH
|
Base Rate |
$326.76
|
$484.63
|
|
OK
|
Base Rate |
$362.99
|
$477.22
|
|
OR
|
Base Rate |
$169.55
|
$517.83
|
|
PA
|
Base Rate |
$337.73
|
$479.52
|
|
PR
|
Base Rate |
$925.99
|
Same |
|
RI
|
Base Rate |
$384.93
|
$512.47
|
|
SC
|
Base Rate |
$384.93
|
$488.53
|
|
SD
|
Base Rate |
$377.39
|
$455.83
|
|
TN
|
Base Rate |
$384.93
|
$488.53
|
|
TX
|
Base Rate |
$362.99
|
$477.22
|
|
UT
|
Base Rate |
$252.68
|
$455.83
|
|
VA
|
Base Rate |
$384.93
|
$479.52
|
|
VI
|
Base Rate |
$526.73
|
Same |
|
VT
|
Base Rate |
$384.93
|
$512.47
|
|
WA
|
Base Rate |
$169.55
|
$517.83
|
|
WI
|
Base Rate |
$326.76
|
$484.63
|
|
WV
|
Base Rate |
$384.93
|
$479.52
|
|
WY
|
Base Rate |
$252.68
|
$455.83
|