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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l0455-prefabricated-tlso-trunk-support
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    HCPCS Level II L0455: Thoracolumbosacral Orthosis (Flexible TLSO)

    HCPCS Level II code L0455 describes a prefabricated, off-the-shelf thoracolumbosacral orthosis (TLSO) that is flexible, provides trunk support from the sacrococcygeal junction to above the T9 vertebra, restricts gross sagittal trunk motion, and uses rigid stays or panels to produce intracavitary pressure to reduce intervertebral disc load; service type: spinal orthosis/brace provision; typical site of service: outpatient durable medical equipment supplier, orthotics clinic, or hospital outpatient setting.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical Guideline, Durable Medical Equipment (DME): Bone Growth Stimulators Medical Guideline.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a middle-aged adult presenting to an outpatient orthotics clinic or spine specialty practice with mid- to low-thoracic and lumbar spine pain after acute exacerbation of chronic degenerative disc disease or following surgical stabilization. The patient reports axial back pain, activity-related worsening, and measurable loss of core stability. After clinical evaluation by a spine surgeon, physiatrist, or orthotist and review of imaging (radiographs or MRI) that demonstrate lumbar degenerative changes, unstable motion segments, or a recent thoracolumbar fracture/healing vertebral compression fracture, the clinician documents medical necessity for external trunk support to limit sagittal plane motion and reduce axial loading.

    The clinical workflow: the ordering clinician documents the diagnosis, specific anatomic levels requiring support (sacrococcygeal junction to above T9), and functional limitations. An orthotist measures the patient, selects a prefabricated TLSO flexible device (L0455) with rigid stays or panels and shoulder straps, fits and adjusts the brace in clinic, provides patient education on use and skin checks, and documents the fitting and medical necessity. Follow-up visits assess symptom response, fit, and need for continuing brace use or transition to custom orthosis. Durable medical equipment suppliers prepare the claim using the supplied modifier(s) and attach the clinical notes, prescription, and fitting documentation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon E/M visit where the clinician documents need for L0455 and writes the prescription.
    97760Orthotic management and training, initial encounter; fitting and training for use of an orthotic deviceOften billed by therapists or orthotists for patient education and initial training with the TLSO.
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or procedureUsed when ancillary supplies related to brace fitting (padding, liners) are provided.
    A9270Noncovered item or serviceNot a CPT code; sometimes used by suppliers when a specific brace component is noncovered and billed separately.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    363LP1700XPerinatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    2084N0402XNeurology with Special Qualifications in Child Neurology PhysicianA Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, e…
    225XH1200XHand Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    207YX0901XOtology & Neurotology PhysicianAn otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology a…
    156FC0801XContact Lens FitterAn optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact …
    207ZP0105XClinical Pathology/Laboratory Medicine PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    5 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01
    General Durable Medical Equipment (DME) Medical GuidelineWPS Health Insurance2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    Related Codes

    HCPCS-L0112-CRANIAL-CERVICAL-ORTHOSIS-CONGENITAL-TORTICOLLIS-CUSTOM

    HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

    HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

    HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

    HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

    HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

    HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

    HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

    HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

    HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

    HCPCS-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

    HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

    HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

    HCPCS Level II L0170: Cervical Collar, Custom-Molded

    HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

    HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

    HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

    HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

    HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

    HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

    Showing 1–10 of 466

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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