HCPCS Level II L1250: TLSO Addition, Low-Profile Anterior ASIS Pad - OpenPayer

Summary & Overview

HCPCS Level II L1250: TLSO Addition, Low-Profile Anterior ASIS Pad

HCPCS Level II code L1250 identifies a low-profile anterior ASIS pad added to a thoracolumbosacral orthosis (TLSO). This orthotic accessory is used to provide localized anterior support at the pelvic brim for patients requiring enhanced anterior stabilization or comfort within a TLSO. Nationally, proper coding for orthotic additions like L1250 matters for accurate device provisioning, billing consistency, and claims adjudication across public and commercial payers.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical role, typical sites of service, and which payers commonly adjudicate claims for orthotic device components. The publication also outlines common modifiers associated with orthotic billing, notes where input data is not available, and describes the operational context for fitting and billing this component.

Readers will learn how L1250 is described in claims, the clinical scenarios in which an anterior ASIS pad is applied to a TLSO, and what to expect in payer coverage patterns at a national level. The document is intended to support coding, claims preparation, and administrative transparency for clinicians, orthotics providers, and billing staff.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL1250HCPCS Level IIthoracolumbosacral orthosisTLSO accessoryorthoticsspine orthosismedical billingdurable medical equipmentorthotic deviceprocedure coding

Billing Code Overview

HCPCS Level II code L1250 denotes an addition to a thoracolumbosacral orthosis (TLSO) designed as a low-profile anterior ASIS pad. The code specifies a component added to an existing TLSO to provide anterior support at the anterior superior iliac spine (ASIS) region.

Service type: orthotic accessory/addition to spinal orthosis

Typical site of service: orthotics/prosthetics facility, outpatient clinic, or hospital outpatient department where orthotic devices are fitted and adjusted

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related billing lines.

Clinical & Coding Specifications

Clinical Context

A patient with a thoracolumbar spinal deformity, postoperative instability, or symptomatic spondylolisthesis is fitted with a thoracolumbar-sacral orthosis (TLSO) that requires a low-profile anterior ASIS (anterior superior iliac spine) padding addition for improved comfort and pressure redistribution. Typical patient: a 56-year-old ambulatory patient 4 weeks post posterior lumbar fusion reporting focal pain and skin irritation over the anterior iliac crest when wearing a low-profile TLSO. An orthotist evaluates the fit in the outpatient orthotics clinic, documents focal contact/erythema over the ASIS, and fabricates and attaches an anterior ASIS pad addition to the existing TLSO to relieve pressure and improve compliance. Workflow: referral from spine surgeon or physiatrist → orthotics evaluation (measurement, skin assessment) → modification fabrication on-site or in lab → fitting and adjustment visit with patient education on wear schedule and skin monitoring → billing using HCPCS level II code L1250 with applicable modifier(s) and accompanying diagnosis codes for the underlying spinal condition or pressure risk.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, 0 or default	Use when reporting the usual, routine service without special circumstances.

HCPCS L2134: KAFO for Femoral Fracture, Semi-Rigid Prefabricated

HCPCS-L1030-LUMBAR-BOLSTER-PAD-ORTHOSIS-ADDITION

HCPCS L1030: Addition to CTLSO or Scoliosis Orthosis — Lumbar Bolster Pad

HCPCS-L3254-NON-STANDARD-SIZE-WIDTH-SUPPLIED-ITEM

HCPCS L3254: Non-standard Size or Width Supply

HCPCS-L3908-WRIST-EXTENSION-COCK-UP-ORTHOSIS-PREFAB

HCPCS L3908: Wrist Extension Control Cock-Up Orthosis, Prefabricated

HCPCS-L1001-INFANT-CT-LS-ORTHOSIS-IMMOBILIZER-PREFABRICATED

HCPCS L1001: Infant Cervical-Thoracic-Lumbar-Sacral Orthosis, Prefabricated

HCPCS-L2660-LOWER-EXTREMITY-THORACIC-CONTROL-THORACIC-BAND

HCPCS L2660: Addition to Lower Extremity Orthosis, Thoracic Control Thoracic Band

HCPCS-L3500-ORTHOPEDIC-INSOLE-LEATHER

HCPCS L3500: Orthopedic Shoe Addition, Leather

HCPCS-L3930-HAND-FINGER-ORTHOSIS-PREFABRICATED

HCPCS L3930: Hand Finger Orthosis, Prefabricated

HCPCS-L0492-PREFABRICATED-TLSO-THREE-SHELL-SAGITTAL-CORONAL-CONTROL

HCPCS L0492: Prefabricated TLSO, Three Rigid Plastic Shells, Sagittal-Coronal Control

HCPCS-L3002-REMOVABLE-MOLDED-FOOT-INSERT-PLASTAZOTE

HCPCS L3002: Removable Molded Foot Insert, Plastazote or Equivalent

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Taxonomy Code	Specialty	Notes
`225100000X`	Orthotist/Prosthetist	Primary clinician who performs orthotic evaluation and modification.
`208D00000X`	Physical Medicine & Rehabilitation (Physiatry)	Referring specialty for postoperative orthotic management and functional goals.
`2080P0207X`	Orthopedic Surgery	Referring or collaborating specialty for spine pathology and orthotic prescriptions.
`207R00000X`	Physical Therapist	May perform gait/functional assessment and support orthotic use and education.
`363L00000X`	Durable Medical Equipment Supplier	Facility/provider taxonomy used for billing durable medical equipment modifications.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M41.26`	Adult idiopathic scoliosis, thoracolumbar region	TLSO with ASIS padding may be used for postural support and pressure relief in thoracolumbar deformity.
`M51.26`	Other intervertebral disc displacement, lumbar region	Lumbar pathology that may require TLSO support and pressure-modifying pads for comfort.
`M48.06`	Spinal stenosis, lumbar region	TLSO prescribed for stabilization and padding added to reduce focal iliac crest pressure.
`M43.16`	Spondylolisthesis, lumbar region	Supportive TLSO with anterior ASIS pad helps offload bony prominences and improve tolerance.
`L89.153`	Pressure ulcer of right hip, stage 3 (example)	ASIS padding addition may be clinically relevant to prevent or manage pressure over ASIS in at-risk patients.
`Z48.81`	Encounter for surgical aftercare following fusion of spine	Postoperative orthotic adjustment including `L1250` is commonly billed during surgical aftercare visits.
`R23.3`	Spontaneous ecchymoses	Localized skin irritation or bruising from TLSO contact may prompt addition of padding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training; fitting and training for orthosis, initial encounter, lower extremity or trunk, with education	Used when the orthotist performs fitting and patient education for a TLSO and documents initial training.
`97763`	Orthotic(s)/prosthetic(s) management and training, lower extremity or trunk, subsequent encounter	Used for follow-up visits for adjustment, troubleshooting, or progressive training after the `L1250` pad addition.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	May be used for billing small additional non-durable supplies associated with modification when payer allows.
`S1040`	Orthotic device supply, modification, or repair (state/local code example)	Some payers request local supply codes for orthotic additions; used when applicable in payer policy.
`A9270`	Non-covered item or service; used for reporting purposes when payer does not cover a specific orthotic modification	Used when a payer denies coverage for the anterior ASIS pad and the supplier bills patient responsibility according to policy.

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