HCPCS Code L0484
Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
| Short Description | Tlso rigid plastic cust fab |
|---|---|
| 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 |