L0491 — Tlso, sagittal-coronal 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 and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
HCPCS Level II L-code · short descriptor: “Tlso 2 piece rigid shell”
- 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
- Face-to-face & WOPD
- Not on the required 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.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
L0491 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $921.20 to $1013.33 depending on state and rural status.
Former-CBA payment limits: ceiling $1124.21 · floor $843.16
| State | Non-rural | Rural |
|---|---|---|
| AK | $921.20 | — |
| AL | $948.92 | — |
| AR | $948.87 | — |
| AZ | $921.20 | — |
| CA | $921.20 | — |
| CO | $954.21 | — |
| CT | $921.22 | — |
| DC | $921.22 | — |
| DE | $921.22 | — |
| FL | $948.92 | — |
| GA | $948.92 | — |
| HI | $921.20 | — |
| IA | $939.21 | — |
| ID | $921.20 | — |
| IL | $943.84 | — |
| IN | $943.84 | — |
| KS | $939.21 | — |
| KY | $948.92 | — |
| LA | $948.87 | — |
| MA | $921.22 | — |
| MD | $921.22 | — |
| ME | $921.22 | — |
| MI | $943.84 | — |
| MN | $943.84 | — |
| MO | $939.21 | — |
| MS | $948.92 | — |
| MT | $954.21 | — |
| NC | $948.92 | — |
| ND | $954.21 | — |
| NE | $939.21 | — |
| NH | $921.22 | — |
| NJ | $921.22 | — |
| NM | $948.87 | — |
| NV | $921.20 | — |
| NY | $921.22 | — |
| OH | $943.84 | — |
| OK | $948.87 | — |
| OR | $921.20 | — |
| PA | $921.22 | — |
| PR | $1013.33 | — |
| RI | $921.22 | — |
| SC | $948.92 | — |
| SD | $954.21 | — |
| TN | $948.92 | — |
| TX | $948.87 | — |
| UT | $954.21 | — |
| VA | $921.22 | — |
| VI | $1013.33 | — |
| VT | $921.22 | — |
| WA | $921.20 | — |
| WI | $943.84 | — |
| WV | $921.22 | — |
| WY | $954.21 | — |
Common denial codes to watch
Related L-codes
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