L0486
Prosthetics & Orthotics
53 States
Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
Short Desc
Tlso rigidlined cust fab two
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$2,166.60
National Ceiling
$2,888.80
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$2,686.86
|
Same |
|
AL
|
Base Rate |
$2,166.60
|
Same |
|
AR
|
Base Rate |
$2,203.61
|
Same |
|
AZ
|
Base Rate |
$2,583.85
|
Same |
|
CA
|
Base Rate |
$2,583.85
|
Same |
|
CO
|
Base Rate |
$2,486.27
|
Same |
|
CT
|
Base Rate |
$2,888.80
|
Same |
|
DC
|
Base Rate |
$2,166.60
|
Same |
|
DE
|
Base Rate |
$2,166.60
|
Same |
|
FL
|
Base Rate |
$2,166.60
|
Same |
|
GA
|
Base Rate |
$2,166.60
|
Same |
|
HI
|
Base Rate |
$2,873.07
|
Same |
|
IA
|
Base Rate |
$2,166.60
|
Same |
|
ID
|
Base Rate |
$2,166.60
|
Same |
|
IL
|
Base Rate |
$2,514.79
|
Same |
|
IN
|
Base Rate |
$2,514.79
|
Same |
|
KS
|
Base Rate |
$2,166.60
|
Same |
|
KY
|
Base Rate |
$2,166.60
|
Same |
|
LA
|
Base Rate |
$2,203.61
|
Same |
|
MA
|
Base Rate |
$2,888.80
|
Same |
|
MD
|
Base Rate |
$2,166.60
|
Same |
|
ME
|
Base Rate |
$2,888.80
|
Same |
|
MI
|
Base Rate |
$2,514.79
|
Same |
|
MN
|
Base Rate |
$2,514.79
|
Same |
|
MO
|
Base Rate |
$2,166.60
|
Same |
|
MS
|
Base Rate |
$2,166.60
|
Same |
|
MT
|
Base Rate |
$2,486.27
|
Same |
|
NC
|
Base Rate |
$2,166.60
|
Same |
|
ND
|
Base Rate |
$2,486.27
|
Same |
|
NE
|
Base Rate |
$2,166.60
|
Same |
|
NH
|
Base Rate |
$2,888.80
|
Same |
|
NJ
|
Base Rate |
$2,325.57
|
Same |
|
NM
|
Base Rate |
$2,203.61
|
Same |
|
NV
|
Base Rate |
$2,583.85
|
Same |
|
NY
|
Base Rate |
$2,325.57
|
Same |
|
OH
|
Base Rate |
$2,514.79
|
Same |
|
OK
|
Base Rate |
$2,203.61
|
Same |
|
OR
|
Base Rate |
$2,166.60
|
Same |
|
PA
|
Base Rate |
$2,166.60
|
Same |
|
PR
|
Base Rate |
$3,711.93
|
Same |
|
RI
|
Base Rate |
$2,888.80
|
Same |
|
SC
|
Base Rate |
$2,166.60
|
Same |
|
SD
|
Base Rate |
$2,486.27
|
Same |
|
TN
|
Base Rate |
$2,166.60
|
Same |
|
TX
|
Base Rate |
$2,203.61
|
Same |
|
UT
|
Base Rate |
$2,486.27
|
Same |
|
VA
|
Base Rate |
$2,166.60
|
Same |
|
VI
|
Base Rate |
$2,325.57
|
Same |
|
VT
|
Base Rate |
$2,888.80
|
Same |
|
WA
|
Base Rate |
$2,166.60
|
Same |
|
WI
|
Base Rate |
$2,514.79
|
Same |
|
WV
|
Base Rate |
$2,166.60
|
Same |
|
WY
|
Base Rate |
$2,486.27
|
Same |