2025 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

TAGS: custom motion anterior symphysis overlapping plaster sternal straps inferior interface piece sacrococcygeal enhanced junction lateral transverse terminates triplanar carved multiple gross pubis extends restricts plastic rigid scapular strength posterior fabricated shell trunk
Short DescriptionTlso rigid plastic cust fab
HCPCS Action Code N - No maintenance for this code
HCPCS Coverage Code C - Carrier judgment
HCPCS Code Added Date January 01, 2003
HCPCS Action Effective Date January 01, 2003
HCPCS Pricing Indicator Code 38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
HCPCS Type Of Service Code P - Lump sum purchase of DME, prosthetics, orthotics
HCPCS Multiple Pricing Indicator Code A - Not applicable as HCPCS priced under one methodology
HCPCS Anesthesia Base Unit Quantity 0
HCPCS Coverage Issues Manual Reference Section Number

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