L0480
Prosthetics & Orthotics
53 States
Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
Short Desc
Tlso rigid plastic custom fa
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2004-01-01
National Floor
$1,636.27
National Ceiling
$2,181.70
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,884.55
|
Same |
|
AL
|
Base Rate |
$1,636.27
|
Same |
|
AR
|
Base Rate |
$1,762.06
|
Same |
|
AZ
|
Base Rate |
$1,859.00
|
Same |
|
CA
|
Base Rate |
$1,859.00
|
Same |
|
CO
|
Base Rate |
$2,033.30
|
Same |
|
CT
|
Base Rate |
$1,913.75
|
Same |
|
DC
|
Base Rate |
$1,636.27
|
Same |
|
DE
|
Base Rate |
$1,636.27
|
Same |
|
FL
|
Base Rate |
$1,636.27
|
Same |
|
GA
|
Base Rate |
$1,636.27
|
Same |
|
HI
|
Base Rate |
$2,015.20
|
Same |
|
IA
|
Base Rate |
$2,119.17
|
Same |
|
ID
|
Base Rate |
$1,912.54
|
Same |
|
IL
|
Base Rate |
$1,856.29
|
Same |
|
IN
|
Base Rate |
$1,856.29
|
Same |
|
KS
|
Base Rate |
$2,119.17
|
Same |
|
KY
|
Base Rate |
$1,636.27
|
Same |
|
LA
|
Base Rate |
$1,762.06
|
Same |
|
MA
|
Base Rate |
$1,913.75
|
Same |
|
MD
|
Base Rate |
$1,636.27
|
Same |
|
ME
|
Base Rate |
$1,913.75
|
Same |
|
MI
|
Base Rate |
$1,856.29
|
Same |
|
MN
|
Base Rate |
$1,856.29
|
Same |
|
MO
|
Base Rate |
$2,119.17
|
Same |
|
MS
|
Base Rate |
$1,636.27
|
Same |
|
MT
|
Base Rate |
$2,033.30
|
Same |
|
NC
|
Base Rate |
$1,636.27
|
Same |
|
ND
|
Base Rate |
$2,033.30
|
Same |
|
NE
|
Base Rate |
$2,119.17
|
Same |
|
NH
|
Base Rate |
$1,913.75
|
Same |
|
NJ
|
Base Rate |
$1,975.61
|
Same |
|
NM
|
Base Rate |
$1,762.06
|
Same |
|
NV
|
Base Rate |
$1,859.00
|
Same |
|
NY
|
Base Rate |
$1,975.61
|
Same |
|
OH
|
Base Rate |
$1,856.29
|
Same |
|
OK
|
Base Rate |
$1,762.06
|
Same |
|
OR
|
Base Rate |
$1,912.54
|
Same |
|
PA
|
Base Rate |
$1,636.27
|
Same |
|
PR
|
Base Rate |
$2,044.31
|
Same |
|
RI
|
Base Rate |
$1,913.75
|
Same |
|
SC
|
Base Rate |
$1,636.27
|
Same |
|
SD
|
Base Rate |
$2,033.30
|
Same |
|
TN
|
Base Rate |
$1,636.27
|
Same |
|
TX
|
Base Rate |
$1,762.06
|
Same |
|
UT
|
Base Rate |
$2,033.30
|
Same |
|
VA
|
Base Rate |
$1,636.27
|
Same |
|
VI
|
Base Rate |
$1,975.61
|
Same |
|
VT
|
Base Rate |
$1,913.75
|
Same |
|
WA
|
Base Rate |
$1,912.54
|
Same |
|
WI
|
Base Rate |
$1,856.29
|
Same |
|
WV
|
Base Rate |
$1,636.27
|
Same |
|
WY
|
Base Rate |
$2,033.30
|
Same |