HCPCS Level IIprostheticsActive
L0480
Tlso rigid plastic custom fa
BETOS: D1F
Effective: 2004-01-01
Referenced in 4 policies
Description
Tlso, triplanar control, one 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, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
Coverage Policies
This code is referenced in 4 Medicare coverage policies
Sample Policies
AMBETTER-CP.MP.107PayerPolicy