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    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l1240-tlso-low-profile-lumbar-derotation-pad
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    HCPCS L1240: Addition to TLSO, Low-Profile Lumbar Derotation Pad

    HCPCS Level II code L1240 describes an addition to a thoracolumbosacral orthosis (TLSO) consisting of a low-profile lumbar derotation pad used to provide rotational control and support for the lumbar spine; the service is an orthotic component intended for use with a TLSO and is typically supplied in an orthotics/prosthetics clinic or outpatient durable medical equipment 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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with a thoracolumbar scoliosis or rotational deformity treated with a thoracolumbar-sacral orthosis (TLSO). The clinician (orthotist or spine specialist) evaluates persistent axial low back pain, progressive lumbar curve derotation needs, or post‑operative stabilization following posterior spinal fusion. The orthotist documents the need for a low‑profile lumbar derotation pad as an addition to the existing TLSO (L1240) to provide focal corrective pressure over the lumbar prominence.

    Workflow: The patient is seen in outpatient orthotics/plastic fabrication or a spine clinic. The orthotist performs a physical and orthotic assessment, documents objective findings (curve measurements, pelvic obliquity, areas of prominence), and determines pad placement. A modification order for L1240 is generated with supporting clinical notes and, if applicable, a physician’s prescription. The pad is custom fitted or attached to the TLSO; fit checks and adjustments occur at the same visit or a short follow‑up. Documentation includes the orthosis serial number, pad description, clinical rationale, measurements, and photos as needed for payor review.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97001Physical therapy evaluationInitial functional evaluation that may document need for orthotic modification and functional goals
    97760Orthotic(s) management and training, upper extremity, lower extremity, and/or trunkEducation and training provided after TLSO modification and pad application
    99070Supplies and materials (over and above usual)Reported when additional custom materials for the low‑profile derotation pad are supplied
    97602Removal of devitalized tissue and/or wound debridement (selective)Included only if pressure‑related skin breakdown necessitates debridement prior to orthotic fitting (uncommon)
    S8140Office visit for prosthetic/orthotic servicesUsed by some payors to report clinic visit for orthotic adjustments and fittings

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    3336L0003XLong Term Care PharmacyA pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermed…
    246ZG1000XMedical Geneticist (PhD) Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Other
    207WX0009XGlaucoma Specialist (Ophthalmology) PhysicianAn ophthalmologist who specializes in the treatment of glaucoma and other disorders related to increased intraocular pressure and optic nerve damage. …
    2278C0205XCritical Care Certified Respiratory TherapistRespiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
    341800000XMilitary/U.S. Coast Guard TransportTransportation Services · Military/U.S. Coast Guard Transport
    385HR2060XChild Intellectual and/or Developmental Disabilities Respite CareA facility or distinct part of a facility that provides short term, residential care to children diagnosed with intellectual and/or developmental disa…

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    G54.3Thoracic root disorders, not elsewhere classified
    M25.561Pain in right knee
    M25.562Pain in left knee
    M41.9Scoliosis, unspecified
    M43.16Spondylolisthesis, lumbar region
    M43.17Spondylolisthesis, lumbosacral region
    M47.816Spondylosis without myelopathy or radiculopathy, lumbar region
    M47.817Spondylosis without myelopathy or radiculopathy, lumbosacral region
    M48.07Spinal stenosis, lumbosacral region
    M51.16Intervertebral disc disorders with radiculopathy, lumbar region

    Showing 1–10 of 26

    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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