L0472 — Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
HCPCS Level II L-code · short descriptor: “Tlso rigid frame hyperex pre”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L0472 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $464.64 to $1237.32 depending on state and rural status.
Former-CBA payment limits: ceiling $619.52 · floor $464.64
| State | Non-rural | Rural |
|---|---|---|
| AK | $666.93 | — |
| AL | $529.16 | — |
| AR | $511.39 | — |
| AZ | $619.52 | — |
| CA | $619.52 | — |
| CO | $464.64 | — |
| CT | $553.82 | — |
| DC | $464.64 | — |
| DE | $464.64 | — |
| FL | $529.16 | — |
| GA | $529.16 | — |
| HI | $713.13 | — |
| IA | $495.01 | — |
| ID | $554.63 | — |
| IL | $497.56 | — |
| IN | $497.56 | — |
| KS | $495.01 | — |
| KY | $529.16 | — |
| LA | $511.39 | — |
| MA | $553.82 | — |
| MD | $464.64 | — |
| ME | $553.82 | — |
| MI | $497.56 | — |
| MN | $497.56 | — |
| MO | $495.01 | — |
| MS | $529.16 | — |
| MT | $464.64 | — |
| NC | $529.16 | — |
| ND | $464.64 | — |
| NE | $495.01 | — |
| NH | $553.82 | — |
| NJ | $556.45 | — |
| NM | $511.39 | — |
| NV | $619.52 | — |
| NY | $556.45 | — |
| OH | $497.56 | — |
| OK | $511.39 | — |
| OR | $554.63 | — |
| PA | $464.64 | — |
| PR | $1237.32 | — |
| RI | $553.82 | — |
| SC | $529.16 | — |
| SD | $464.64 | — |
| TN | $529.16 | — |
| TX | $511.39 | — |
| UT | $464.64 | — |
| VA | $464.64 | — |
| VI | $556.45 | — |
| VT | $553.82 | — |
| WA | $554.63 | — |
| WI | $497.56 | — |
| WV | $464.64 | — |
| WY | $464.64 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related L-codes
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