HCPCS Code L0458

Official Description

Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

Date	Action	Notes
2011-01-01	Changed	Minor CMS change - change spelling from TRANVERSE to TRANSVERSE
2003-01-01	Added	Added

Date

Action

Notes

2011-01-01

Changed

Minor CMS change - change spelling from TRANVERSE to TRANSVERSE

2003-01-01

Added

Code	Description

No matching codes found

Code

Description

Short Descr	Tlso 2mod symphis-xipho pre
Coverage	Carrier Priced
Pricing Indicator(s)	38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI	A – Not applicable, as HCPCS priced under one methodology
BETOS	D1F – Prosthetic/Orthotic devices
TOS Code(s)	P – Lump sum purchase of DME, prosthetics, orthotics
Added Date	1/1/2003
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	0
MUE	1
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

CG	Policy criteria applied
KV	Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
KX	Requirements specified in the medical policy have been met

HCPCS Code L0458

Official Description

Code Data Insights

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Chapter & Section Hierarchy

Code History

ICD-10-CM Crosswalk