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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l0490-tlso-sagittal-coronal-control-prefab-rigid-shell
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    HCPCS Level II L0490: TLSO One-Piece Rigid Sagittal-Coronal Control

    HCPCS Level II code L0490 describes a prefabricated one-piece rigid plastic TLSO (thoracolumbosacral orthosis) with overlapping reinforced anterior, multiple straps and closures, an anterior opening, posterior extension from the sacrococcygeal junction up to T9 and an anterior that extends from the symphysis pubis to the xiphoid; service type: spinal orthosis fabrication and fitting; typical site of service: outpatient orthotics/prosthetics clinic or hospital orthotics department, includes fitting and adjustment.

    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 56-year-old male presents to the orthotics clinic following a multi-level thoracolumbar compression fracture and progressive kyphosis after a traumatic fall. The patient reports midline thoracolumbar pain, reduced trunk stability, and difficulty with activities of daily living. Imaging confirms unstable compression fractures at L1–L3 with anterior column compromise and coronal/sagittal malalignment.

    The treating spine surgeon prescribes a prefabricated one-piece rigid TLSO with sagittal-coronal control (L0490) to restrict gross trunk motion in sagittal and coronal planes, support healing, and provide temporary immobilization prior to or following surgical stabilization. A certified orthotist measures the patient, selects the appropriate prefabricated size, fits the overlapping reinforced anterior shell, adjusts multiple straps and closures, and documents fitting and adjustment time. Typical workflow includes outpatient orthotics visit for initial fitting, patient education on donning/doffing and skin checks, follow-up visits for strap adjustments and pressure point assessments, and coordination with the spine surgeon for duration of use and return-to-activity guidance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, initial encounter, specifying training in use of device, fitting, and adjustment; 15 minutesOften performed by a physical therapist or orthotist to instruct the patient in donning/doffing, safety, and mobility with the TLSO.
    97763Orthotic/prosthetic management and training, subsequent encounterUsed for follow-up training sessions and ongoing adjustment visits after initial fitting.
    99203Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutesUsed by the prescribing physician (e.g., spine surgeon or physiatrist) when evaluating and prescribing the TLSO.
    99213Office or other outpatient visit for established patient, typically 15 minutesUsed for routine follow-up visits to assess brace tolerance and healing progress.
    99070Supplies and materials (except spectacles), provided by the physician over and above the usual supply of the physician's officeMay be used for additional non-DMEPOS items provided at fitting (subject to payer rules).

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    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…
    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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    225100000XPhysical TherapistPhysical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    363LG0600XGerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    2279E0002XEmergency Care Registered Respiratory TherapistThe immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…
    363LP0808XPsychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207SC0300XClinical Cytogenetics PhysicianA clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular componen…

    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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