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What is the CPT Code for a Modular TLSO with Triplanar Control?

Custom-Fit Modular TLSO with Triplanar Control HCPCS Code L0464

To bill for custom-fit thoracolumbosacral orthoses (TLSOs) with triplanar control, you'll need to use HCPCS Level II codes, which are designed for healthcare products and services that fall outside the CPT system. All bracing and orthotic devices are categorized under the "L" series of HCPCS codes.

HCPCS Code:

L0464

Definition:

Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

This code applies to custom-fit modular TLSOs, designed for triplanar control of the spine. These orthoses include four rigid plastic shells with soft liners, extending from the sacrococcygeal junction to just below the scapular spine in the back, and from the symphysis pubis to the sternal notch in the front. They restrict motion in the sagittal, coronal, and transverse planes while providing lateral strength through overlapping plastic components. Adjusted and fitted by healthcare professionals, these TLSOs ensure optimal stabilization and Medicare compliance.

Clinical Use Cases for L0464 Custom-Fit Modular TLSOs

Post-Surgical Recovery

Provides precise stabilization and triplanar motion restriction for patients recovering from spinal surgeries, such as fusion or vertebral fracture repair.

Complex Spinal Conditions

Offers triplanar control for managing severe spinal deformities, such as scoliosis, kyphosis, or advanced degenerative disc disease.

Severe Spinal Trauma

Stabilizes the thoracic and lumbar spine following significant trauma, restricting motion in all planes to protect the spine and support healing.

Why Healthcare Providers Choose Brace Direct

  • Customer Service at Brace Direct is efficient, knowledgeable, and helpful.

    Comprehensive Product Selection

    Our extensive range of PDAC-approved braces ensures you'll find the perfect solution for every patient's unique needs. From off-the-shelf options to specialized supports, we provide high-quality products that meet stringent medical standards.

  • Streamlined Ordering Process

    Our user-friendly online platform allows for quick and efficient product selection. Search by specific codes, patient conditions, or product features to find exactly what you need with minimal effort.

  • Expert Clinical Support

    Access a wealth of educational resources including detailed fitting guides, instructional videos, and direct support from our team of bracing specialists. We're committed to supporting healthcare providers in delivering optimal patient care.

Cost-Effective Solutions

Benefit from competitive pricing, volume discounts, and our Provider Discount Program. We help you manage costs without compromising on the quality of patient care and support.

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Provider Discount Program

Save on wholesale orders and access exclusive volume discounts for your practice. Our program makes it easy to stock high-quality, PDAC-approved braces at competitive prices, ensuring your patients receive the best care while keeping your costs low.

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Explore Our PDAC L0464 Approved Custom-Fit Modular TLSOs

Ensure your patients receive advanced spinal stabilization with our custom-fit modular TLSOs. Designed for triplanar control and tailored to individual needs by healthcare professionals, these orthoses deliver effective care and Medicare compliance.

View Custom-Fit Modular TLSO Collection

Frequently Asked Questions

How can I ensure correct billing for DME (Durable Medical Equipment)? +

To bill for DME, you’ll need proper documentation, including patient diagnosis, medical necessity, and a detailed prescription. Be sure to use the appropriate modifiers (e.g., KX, RT, LT) and maintain compliance with Medicare guidelines.

Why doesn't Brace Direct work with insurance or Medicare? +

Brace Direct follows a direct-to-consumer model to offer affordable prices, upfront pricing transparency, and faster access to braces without the delays and complexities of insurance or Medicare billing. Many products are FSA and HSA eligible for added convenience.
Direct-to-Consumer Medical Braces & Supports: No Insurance Hassles

How does Brace Direct support healthcare providers? +

We offer an extensive range of PDAC-approved products, educational resources, and a user-friendly ordering platform. Additionally, our Provider Discount Program helps practices manage costs while delivering high-quality care.

What does PDAC approval mean, and why is it important? +

PDAC (Pricing, Data Analysis, and Coding) approval ensures that a brace meets Medicare’s strict requirements for quality, design, and function. Using PDAC-approved products simplifies reimbursement processes and helps avoid claim denials.

Where can I learn more about Medicare's requirements for braces and billing? +

For more details on Medicare’s coding and reimbursement guidelines for orthotics, visit the official Medicare website below.
Medicare's DME Coverage

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