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HCPCS
L0490

HCPCS Code L0490

Official Description

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 Descr Tlso rigid plastic pre one
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
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
Code
Description
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