L0472
Prosthetics & Orthotics
53 States
Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
Short Desc
Tlso rigid frame hyperex pre
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$464.64
National Ceiling
$619.52
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$666.93
|
Same |
|
AL
|
Base Rate |
$529.16
|
Same |
|
AR
|
Base Rate |
$511.39
|
Same |
|
AZ
|
Base Rate |
$619.52
|
Same |
|
CA
|
Base Rate |
$619.52
|
Same |
|
CO
|
Base Rate |
$464.64
|
Same |
|
CT
|
Base Rate |
$553.82
|
Same |
|
DC
|
Base Rate |
$464.64
|
Same |
|
DE
|
Base Rate |
$464.64
|
Same |
|
FL
|
Base Rate |
$529.16
|
Same |
|
GA
|
Base Rate |
$529.16
|
Same |
|
HI
|
Base Rate |
$713.13
|
Same |
|
IA
|
Base Rate |
$495.01
|
Same |
|
ID
|
Base Rate |
$554.63
|
Same |
|
IL
|
Base Rate |
$497.56
|
Same |
|
IN
|
Base Rate |
$497.56
|
Same |
|
KS
|
Base Rate |
$495.01
|
Same |
|
KY
|
Base Rate |
$529.16
|
Same |
|
LA
|
Base Rate |
$511.39
|
Same |
|
MA
|
Base Rate |
$553.82
|
Same |
|
MD
|
Base Rate |
$464.64
|
Same |
|
ME
|
Base Rate |
$553.82
|
Same |
|
MI
|
Base Rate |
$497.56
|
Same |
|
MN
|
Base Rate |
$497.56
|
Same |
|
MO
|
Base Rate |
$495.01
|
Same |
|
MS
|
Base Rate |
$529.16
|
Same |
|
MT
|
Base Rate |
$464.64
|
Same |
|
NC
|
Base Rate |
$529.16
|
Same |
|
ND
|
Base Rate |
$464.64
|
Same |
|
NE
|
Base Rate |
$495.01
|
Same |
|
NH
|
Base Rate |
$553.82
|
Same |
|
NJ
|
Base Rate |
$556.45
|
Same |
|
NM
|
Base Rate |
$511.39
|
Same |
|
NV
|
Base Rate |
$619.52
|
Same |
|
NY
|
Base Rate |
$556.45
|
Same |
|
OH
|
Base Rate |
$497.56
|
Same |
|
OK
|
Base Rate |
$511.39
|
Same |
|
OR
|
Base Rate |
$554.63
|
Same |
|
PA
|
Base Rate |
$464.64
|
Same |
|
PR
|
Base Rate |
$1,237.32
|
Same |
|
RI
|
Base Rate |
$553.82
|
Same |
|
SC
|
Base Rate |
$529.16
|
Same |
|
SD
|
Base Rate |
$464.64
|
Same |
|
TN
|
Base Rate |
$529.16
|
Same |
|
TX
|
Base Rate |
$511.39
|
Same |
|
UT
|
Base Rate |
$464.64
|
Same |
|
VA
|
Base Rate |
$464.64
|
Same |
|
VI
|
Base Rate |
$556.45
|
Same |
|
VT
|
Base Rate |
$553.82
|
Same |
|
WA
|
Base Rate |
$554.63
|
Same |
|
WI
|
Base Rate |
$497.56
|
Same |
|
WV
|
Base Rate |
$464.64
|
Same |
|
WY
|
Base Rate |
$464.64
|
Same |