HCPCS Code L0458
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
| Short Description | Tlso 2mod symphis-xipho pre |
|---|---|
| Year | 2026 |
| Coverage Code | C = Carrier judgment |
| Action Code | N = No maintenance for this code |
| Action Effective Date | January 01, 2003 |
| Code Added Date | January 01, 2003 |
| Pricing Indicator | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) |
| Type of Service | P = Lump sum purchase of DME, prosthetics, orthotics |