MyMedi-AI

L0974 — Tlso, full corset

HCPCS Level II L-code · short descriptor: “Tlso full corset”

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
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L0974 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $133.09 to $285.59 depending on state and rural status.

Former-CBA payment limits: ceiling $274.31 · floor $205.73

StateNon-ruralRural
AK$267.05—
AL$274.31—
AR$230.94—
AZ$265.14—
CA$265.14—
CO$205.73—
CT$259.23—
DC$206.10—
DE$206.10—
FL$274.31—
GA$274.31—
HI$285.59—
IA$219.19—
ID$212.89—
IL$214.76—
IN$214.76—
KS$219.19—
KY$274.31—
LA$230.94—
MA$259.23—
MD$206.10—
ME$259.23—
MI$214.76—
MN$214.76—
MO$219.19—
MS$274.31—
MT$205.73—
NC$274.31—
ND$205.73—
NE$219.19—
NH$259.23—
NJ$205.73—
NM$230.94—
NV$265.14—
NY$205.73—
OH$214.76—
OK$230.94—
OR$212.89—
PA$206.10—
PR$133.09—
RI$259.23—
SC$274.31—
SD$205.73—
TN$274.31—
TX$230.94—
UT$205.73—
VA$206.10—
VI$205.73—
VT$259.23—
WA$212.89—
WI$214.76—
WV$206.10—
WY$205.73—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L0974 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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