L0488
Prosthetics & Orthotics
53 States
Tlso, triplanar control, one 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, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment
Short Desc
Tlso rigid lined pre one pie
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$1,102.07
National Ceiling
$1,469.43
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,204.08
|
Same |
|
AL
|
Base Rate |
$1,240.37
|
Same |
|
AR
|
Base Rate |
$1,240.27
|
Same |
|
AZ
|
Base Rate |
$1,204.08
|
Same |
|
CA
|
Base Rate |
$1,204.08
|
Same |
|
CO
|
Base Rate |
$1,247.22
|
Same |
|
CT
|
Base Rate |
$1,204.08
|
Same |
|
DC
|
Base Rate |
$1,204.08
|
Same |
|
DE
|
Base Rate |
$1,204.08
|
Same |
|
FL
|
Base Rate |
$1,240.37
|
Same |
|
GA
|
Base Rate |
$1,240.37
|
Same |
|
HI
|
Base Rate |
$1,204.08
|
Same |
|
IA
|
Base Rate |
$1,227.63
|
Same |
|
ID
|
Base Rate |
$1,204.08
|
Same |
|
IL
|
Base Rate |
$1,233.68
|
Same |
|
IN
|
Base Rate |
$1,233.68
|
Same |
|
KS
|
Base Rate |
$1,227.63
|
Same |
|
KY
|
Base Rate |
$1,240.37
|
Same |
|
LA
|
Base Rate |
$1,240.27
|
Same |
|
MA
|
Base Rate |
$1,204.08
|
Same |
|
MD
|
Base Rate |
$1,204.08
|
Same |
|
ME
|
Base Rate |
$1,204.08
|
Same |
|
MI
|
Base Rate |
$1,233.68
|
Same |
|
MN
|
Base Rate |
$1,233.68
|
Same |
|
MO
|
Base Rate |
$1,227.63
|
Same |
|
MS
|
Base Rate |
$1,240.37
|
Same |
|
MT
|
Base Rate |
$1,247.22
|
Same |
|
NC
|
Base Rate |
$1,240.37
|
Same |
|
ND
|
Base Rate |
$1,247.22
|
Same |
|
NE
|
Base Rate |
$1,227.63
|
Same |
|
NH
|
Base Rate |
$1,204.08
|
Same |
|
NJ
|
Base Rate |
$1,204.08
|
Same |
|
NM
|
Base Rate |
$1,240.27
|
Same |
|
NV
|
Base Rate |
$1,204.08
|
Same |
|
NY
|
Base Rate |
$1,204.08
|
Same |
|
OH
|
Base Rate |
$1,233.68
|
Same |
|
OK
|
Base Rate |
$1,240.27
|
Same |
|
OR
|
Base Rate |
$1,204.08
|
Same |
|
PA
|
Base Rate |
$1,204.08
|
Same |
|
PR
|
Base Rate |
$1,324.46
|
Same |
|
RI
|
Base Rate |
$1,204.08
|
Same |
|
SC
|
Base Rate |
$1,240.37
|
Same |
|
SD
|
Base Rate |
$1,247.22
|
Same |
|
TN
|
Base Rate |
$1,240.37
|
Same |
|
TX
|
Base Rate |
$1,240.27
|
Same |
|
UT
|
Base Rate |
$1,247.22
|
Same |
|
VA
|
Base Rate |
$1,204.08
|
Same |
|
VI
|
Base Rate |
$1,324.46
|
Same |
|
VT
|
Base Rate |
$1,204.08
|
Same |
|
WA
|
Base Rate |
$1,204.08
|
Same |
|
WI
|
Base Rate |
$1,233.68
|
Same |
|
WV
|
Base Rate |
$1,204.08
|
Same |
|
WY
|
Base Rate |
$1,247.22
|
Same |