L0490 — Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment
HCPCS Level II L-code · short descriptor: “Tlso rigid plastic pre one”
- 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.
L0490 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $339.33 to $407.11 depending on state and rural status.
Former-CBA payment limits: ceiling $414.08 · floor $310.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $339.33 | — |
| AL | $349.51 | — |
| AR | $349.48 | — |
| AZ | $339.33 | — |
| CA | $339.33 | — |
| CO | $351.43 | — |
| CT | $339.33 | — |
| DC | $339.33 | — |
| DE | $339.33 | — |
| FL | $349.51 | — |
| GA | $349.51 | — |
| HI | $339.33 | — |
| IA | $345.93 | — |
| ID | $339.33 | — |
| IL | $347.64 | — |
| IN | $347.64 | — |
| KS | $345.93 | — |
| KY | $349.51 | — |
| LA | $349.48 | — |
| MA | $339.33 | — |
| MD | $339.33 | — |
| ME | $339.33 | — |
| MI | $347.64 | — |
| MN | $347.64 | — |
| MO | $345.93 | — |
| MS | $349.51 | — |
| MT | $351.43 | — |
| NC | $349.51 | — |
| ND | $351.43 | — |
| NE | $345.93 | — |
| NH | $339.33 | — |
| NJ | $339.33 | — |
| NM | $349.48 | — |
| NV | $339.33 | — |
| NY | $339.33 | — |
| OH | $347.64 | — |
| OK | $349.48 | — |
| OR | $339.33 | — |
| PA | $339.33 | — |
| PR | $407.11 | — |
| RI | $339.33 | — |
| SC | $349.51 | — |
| SD | $351.43 | — |
| TN | $349.51 | — |
| TX | $349.48 | — |
| UT | $351.43 | — |
| VA | $339.33 | — |
| VI | $407.11 | — |
| VT | $339.33 | — |
| WA | $339.33 | — |
| WI | $347.64 | — |
| WV | $339.33 | — |
| WY | $351.43 | — |
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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