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HCPCS Range Low-profile Additions, Thoracic-lumbar-sacral Orthotics

• 1 Thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only ( L1200 )

• 2 Addition to Thoracic-lumbar-sacral-orthosis (TLSO), (low profile), lateral thoracic extension ( L1210 )

• 3 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior thoracic extension ( L1220 )

• 4 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), Milwaukee type superstructure ( L1230 )

• 5 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad ( L1240 )

• 6 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior asis pad ( L1250 )

• 7 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior thoracic derotation pad ( L1260 )

• 8 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), abdominal pad ( L1270 )

• 9 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), rib gusset (elastic), each ( L1280 )

• 10 Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral trochanteric pad ( L1290 )