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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l1040-lumbar-pad-addition-to-ct-lso-scoliosis-orthosis
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    HCPCS Level II L1040: Lumbar/Lumbar Rib Pad for Scoliosis Orthosis

    HCPCS Level II code L1040 identifies an addition to a CTLSO or scoliosis orthosis consisting of a lumbar or lumbar rib pad, used as an orthotic component to provide targeted support and pressure redistribution for the lumbar spine in patients with scoliosis; service type: orthotic accessory/addition, typical site of service: outpatient durable medical equipment or orthotics/prosthetics clinic.

    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 14-year-old adolescent with progressive idiopathic scoliosis who recently had a custom thoracolumbosacral orthosis (TLSO) fabricated. During a follow-up orthotics clinic visit the patient reports focal lumbar discomfort and the treating orthotist documents inadequate pressure distribution in the lumbar region. The orthotist adds a lumbar or lumbar-rib pad as an addition to the existing TLSO to improve support and redistribute corrective forces. The workflow includes: initial evaluation by an orthotist or orthopedic surgeon, measurement and fitting of the TLSO, identification of the need for a lumbar pad at follow-up, fabrication or attachment of the lumbar/lumbar-rib pad to the existing orthosis, post-fit adjustment and patient education on use, and documentation of the addition to the orthosis specifying L1040 as the HCPCS Level II code. Typical site of service is an outpatient orthotics/prosthetics clinic, pediatric orthopedic clinic, or durable medical equipment supplier with in-clinic fitting services. The patient scenario may also occur for adult patients with degenerative lumbar scoliosis or postural deformity needing supplemental lumbar padding to improve comfort and brace efficacy.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s) fitting and training, initial encounter, each 15 minutesUsed when a patient requires dedicated fitting and training time for the TLSO and added lumbar pad.
    97762Checkout for orthotic/prosthetic use, established patient, each 15 minutesUsed for follow-up visits to check fit and function after the lumbar pad addition.
    99070Supplies and materials (eg, noncovered services) used during patient care, not included in other codesUsed when noncovered padding materials or custom components are provided during modification.
    99455Work-related or medical disability examination services (detailed assessment)May be used when orthotic modifications are part of a functional capacity evaluation or work-related assessment.
    97001Physical therapy evaluation (Note: replaced in many settings by 97161–97164)Relevant when a therapist performs evaluation related to brace use and tolerance; include modern equivalents as appropriate.

    If payer requires more specific procedural coding for minor fabrication/modification services, these CPT codes are commonly used in the clinical workflow surrounding L1040 additions to a TLSO/scoliosis orthosis.

    Related Modifiers

    9 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…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    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…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    213E00000XPodiatristA podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that l…
    207YP0228XPediatric Otolaryngology PhysicianA pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired condi…
    2278P3900XNeonatal/Pediatric Certified Respiratory TherapistThe care and treatment of premature infants, newborns and children. This includes management of mechanical ventilation, assessment, diagnostics and g…
    152WS0006XSports Vision OptometristAn optometrist who offers services designed to care for unique vision care needs of athletes, which may include one of more of the following services:…
    2080S0010XPediatric Sports Medicine PhysicianA pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also fo…

    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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