L0468 HCPCS code: Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0468 is the HCPCS Level II code for tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. The 2026 Medicare DMEPOS fee schedule pays $526.74 to $1,313.47 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Its average fee ranks 9 of 23 L04 codes (family range $136.07–$2,412.38).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2003-01-01 |
| Last action effective | 2014-01-01 |
2026 Medicare DMEPOS fee schedule for L0468
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $526.74 | $1,313.47 | $702.32 | $526.74 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $666.61 | — |
| AL | — | $592.16 | — |
| AR | — | $569.51 | — |
| AZ | — | $693.80 | — |
| CA | — | $693.80 | — |
| CO | — | $526.74 | — |
| CT | — | $640.02 | — |
| DC | — | $574.13 | — |
| DE | — | $574.13 | — |
| FL | — | $592.16 | — |
| GA | — | $592.16 | — |
| HI | — | $712.79 | — |
| IA | — | $569.60 | — |
| ID | — | $650.73 | — |
| IL | — | $584.34 | — |
| IN | — | $584.34 | — |
| KS | — | $569.60 | — |
| KY | — | $592.16 | — |
| LA | — | $569.51 | — |
| MA | — | $640.02 | — |
| MD | — | $574.13 | — |
| ME | — | $640.02 | — |
| MI | — | $584.34 | — |
| MN | — | $584.34 | — |
| MO | — | $569.60 | — |
| MS | — | $592.16 | — |
| MT | — | $526.74 | — |
| NC | — | $592.16 | — |
| ND | — | $526.74 | — |
| NE | — | $569.60 | — |
| NH | — | $640.02 | — |
| NJ | — | $526.74 | — |
| NM | — | $569.51 | — |
| NV | — | $693.80 | — |
| NY | — | $526.74 | — |
| OH | — | $584.34 | — |
| OK | — | $569.51 | — |
| OR | — | $650.73 | — |
| PA | — | $574.13 | — |
| PR | — | $1,313.47 | — |
| RI | — | $640.02 | — |
| SC | — | $592.16 | — |
| SD | — | $526.74 | — |
| TN | — | $592.16 | — |
| TX | — | $569.51 | — |
| UT | — | $526.74 | — |
| VA | — | $574.13 | — |
| VI | — | $526.74 | — |
| VT | — | $640.02 | — |
| WA | — | $650.73 | — |
| WI | — | $584.34 | — |
| WV | — | $574.13 | — |
| WY | — | $526.74 | — |
How the L0468 fee compares
| Measure | Value |
|---|---|
| Rank among 23 L04 codes (lowest = 1) | 9 |
| Family fee range (average of state fees) | $136.07–$2,412.38 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Anatomic Consideration |
| outpatient hospital claims | 1 | Anatomic Consideration |
What changed for L0468
- 2026-01-01: Average state fee rose 2.0%: $594.18 to $606.06
- 2003-01-01: L0468 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L0468?
L0468 is the HCPCS Level II code for tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. Short descriptor: "Tlso rig fram pelvic pre cst".
How much does Medicare pay for L0468?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $526.74–$1,313.47. Rural fees can be higher.
Does Medicare cover L0468?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0468 change in 2026?
The average non-rural state fee moved from $594.18 in 2025 to $606.06 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0468 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L04 codes
- L0450 — Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf ($63.92–$252.57)
- L0452 — Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated
- L0454 — Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($416.01–$457.64)
- L0455 — Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf ($118.65–$417.25)
- L0456 — Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($1,192.99–$1,312.31)
- L0457 — Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf ($340.25–$1,196.50)
- L0458 — Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment ($1,069.75–$1,176.76)
- L0460 — Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($1,204.08–$1,324.46)
- L0462 — Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment ($1,497.69–$1,647.47)
- L0464 — Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment ($1,782.97–$1,961.28)
- L0466 — Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($276.04–$624.40)
- L0467 — Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf ($133.07–$523.52)
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Next steps
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Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.