L0490
Prosthetics & Orthotics
53 States
Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment
Short Desc
Tlso rigid plastic pre one
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$310.56
National Ceiling
$414.08
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$339.33
|
Same |
|
AL
|
Base Rate |
$349.51
|
Same |
|
AR
|
Base Rate |
$349.48
|
Same |
|
AZ
|
Base Rate |
$339.33
|
Same |
|
CA
|
Base Rate |
$339.33
|
Same |
|
CO
|
Base Rate |
$351.43
|
Same |
|
CT
|
Base Rate |
$339.33
|
Same |
|
DC
|
Base Rate |
$339.33
|
Same |
|
DE
|
Base Rate |
$339.33
|
Same |
|
FL
|
Base Rate |
$349.51
|
Same |
|
GA
|
Base Rate |
$349.51
|
Same |
|
HI
|
Base Rate |
$339.33
|
Same |
|
IA
|
Base Rate |
$345.93
|
Same |
|
ID
|
Base Rate |
$339.33
|
Same |
|
IL
|
Base Rate |
$347.64
|
Same |
|
IN
|
Base Rate |
$347.64
|
Same |
|
KS
|
Base Rate |
$345.93
|
Same |
|
KY
|
Base Rate |
$349.51
|
Same |
|
LA
|
Base Rate |
$349.48
|
Same |
|
MA
|
Base Rate |
$339.33
|
Same |
|
MD
|
Base Rate |
$339.33
|
Same |
|
ME
|
Base Rate |
$339.33
|
Same |
|
MI
|
Base Rate |
$347.64
|
Same |
|
MN
|
Base Rate |
$347.64
|
Same |
|
MO
|
Base Rate |
$345.93
|
Same |
|
MS
|
Base Rate |
$349.51
|
Same |
|
MT
|
Base Rate |
$351.43
|
Same |
|
NC
|
Base Rate |
$349.51
|
Same |
|
ND
|
Base Rate |
$351.43
|
Same |
|
NE
|
Base Rate |
$345.93
|
Same |
|
NH
|
Base Rate |
$339.33
|
Same |
|
NJ
|
Base Rate |
$339.33
|
Same |
|
NM
|
Base Rate |
$349.48
|
Same |
|
NV
|
Base Rate |
$339.33
|
Same |
|
NY
|
Base Rate |
$339.33
|
Same |
|
OH
|
Base Rate |
$347.64
|
Same |
|
OK
|
Base Rate |
$349.48
|
Same |
|
OR
|
Base Rate |
$339.33
|
Same |
|
PA
|
Base Rate |
$339.33
|
Same |
|
PR
|
Base Rate |
$407.11
|
Same |
|
RI
|
Base Rate |
$339.33
|
Same |
|
SC
|
Base Rate |
$349.51
|
Same |
|
SD
|
Base Rate |
$351.43
|
Same |
|
TN
|
Base Rate |
$349.51
|
Same |
|
TX
|
Base Rate |
$349.48
|
Same |
|
UT
|
Base Rate |
$351.43
|
Same |
|
VA
|
Base Rate |
$339.33
|
Same |
|
VI
|
Base Rate |
$407.11
|
Same |
|
VT
|
Base Rate |
$339.33
|
Same |
|
WA
|
Base Rate |
$339.33
|
Same |
|
WI
|
Base Rate |
$347.64
|
Same |
|
WV
|
Base Rate |
$339.33
|
Same |
|
WY
|
Base Rate |
$351.43
|
Same |