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HCPCS Procedure & Supply Codes

Orthotic Devices & Services

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Orthotic Devices -- Scoliosis

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Thoracic-Lumbar-Sacral Orthosis (TLSO) (Low Profile)

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L1200   Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
L1210   Addition to tlso, (low profile), lateral thoracic extension
L1220   Addition to tlso, (low profile), anterior thoracic extension
L1230   Addition to tlso, (low profile), milwaukee type superstructure
L1240   Addition to tlso, (low profile), lumbar derotation pad
L1250   Addition to tlso, (low profile), anterior asis pad
L1260   Addition to tlso, (low profile), anterior thoracic derotation pad
L1270   Addition to tlso, (low profile), abdominal pad
L1280   Addition to tlso, (low profile), rib gusset (elastic), each
L1290   Addition to tlso, (low profile), lateral trochanteric pad
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