Table of content for "Tlso 2mod symphis-xipho pre" (HCPCS L0458)
General information on the “L0458” code
HCPCS Code: L0458
Long Description: 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
Original information is taken from L0458 page
Pricing indicators
Pricing Indicator Code 1: 38 – Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) . Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
Type of service
Berenson-Eggers Type of Service (BETOS): D1F – Prosthetic/Orthotic devices
Type Of Service 1: P – Lump sum purchase of DME, prosthetics, orthotics
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20030101
Code Effective Date: 20030101
Action Code: N – No maintenance for this code