L0486 HCPCS code: Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
L0486 is the HCPCS Level II code for tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $2,166.60 to $3,711.93 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. Medicare volume rose 98% from 2022 to 2024 (559 to 1,105 services). In 2024, 263 suppliers billed Medicare for L0486 (purchases), serving 1,105 beneficiaries; Arizona, Texas, Colorado accounted for 21% of services. Its average fee ranks 23 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 | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for L0486
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $2,166.60 | $3,711.93 | $2,888.80 | $2,166.60 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $2,686.86 | — |
| AL | — | $2,166.60 | — |
| AR | — | $2,203.61 | — |
| AZ | — | $2,583.85 | — |
| CA | — | $2,583.85 | — |
| CO | — | $2,486.27 | — |
| CT | — | $2,888.80 | — |
| DC | — | $2,166.60 | — |
| DE | — | $2,166.60 | — |
| FL | — | $2,166.60 | — |
| GA | — | $2,166.60 | — |
| HI | — | $2,873.07 | — |
| IA | — | $2,166.60 | — |
| ID | — | $2,166.60 | — |
| IL | — | $2,514.79 | — |
| IN | — | $2,514.79 | — |
| KS | — | $2,166.60 | — |
| KY | — | $2,166.60 | — |
| LA | — | $2,203.61 | — |
| MA | — | $2,888.80 | — |
| MD | — | $2,166.60 | — |
| ME | — | $2,888.80 | — |
| MI | — | $2,514.79 | — |
| MN | — | $2,514.79 | — |
| MO | — | $2,166.60 | — |
| MS | — | $2,166.60 | — |
| MT | — | $2,486.27 | — |
| NC | — | $2,166.60 | — |
| ND | — | $2,486.27 | — |
| NE | — | $2,166.60 | — |
| NH | — | $2,888.80 | — |
| NJ | — | $2,325.57 | — |
| NM | — | $2,203.61 | — |
| NV | — | $2,583.85 | — |
| NY | — | $2,325.57 | — |
| OH | — | $2,514.79 | — |
| OK | — | $2,203.61 | — |
| OR | — | $2,166.60 | — |
| PA | — | $2,166.60 | — |
| PR | — | $3,711.93 | — |
| RI | — | $2,888.80 | — |
| SC | — | $2,166.60 | — |
| SD | — | $2,486.27 | — |
| TN | — | $2,166.60 | — |
| TX | — | $2,203.61 | — |
| UT | — | $2,486.27 | — |
| VA | — | $2,166.60 | — |
| VI | — | $2,325.57 | — |
| VT | — | $2,888.80 | — |
| WA | — | $2,166.60 | — |
| WI | — | $2,514.79 | — |
| WV | — | $2,166.60 | — |
| WY | — | $2,486.27 | — |
How the L0486 fee compares
| Measure | Value |
|---|---|
| Rank among 23 L04 codes (lowest = 1) | 23 |
| Family fee range (average of state fees) | $136.07–$2,412.38 |
| Rural fee uplift | — |
Who bills L0486 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 263 |
| Referring clinicians | 432 |
| Medicare beneficiaries | 1,105 |
| States with claims | 34 |
| Share of services in top 3 states (Arizona, Texas, Colorado) | 21% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 291 | 559 |
| 2023 | 296 | 533 |
| 2024 | 263 | 1,105 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L0486, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 559 | 559 | $2,052.27 | $1,606.53 |
| 2023 | 533 | 533 | $2,231.08 | $1,735.74 |
| 2024 | 1,105 | 1,105 | $2,144.75 | $1,674.09 |
States with the most L0486 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Arizona | 98 | $1,707.49 |
| Texas | 60 | $1,614.38 |
| Colorado | 60 | $1,665.25 |
| Florida | 52 | $1,609.22 |
| Illinois | 52 | $1,702.74 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Anatomic Consideration |
| outpatient hospital claims | 1 | Anatomic Consideration |
Medicare policy articles for this code
- A52500: Spinal Orthoses: TLSO and LSO - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for L0486
- 2026-01-01: Average state fee rose 2.0%: $2,365.08 to $2,412.38
- 2003-01-01: L0486 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 L0486?
L0486 is the HCPCS Level II code for tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated. Short descriptor: "Tlso rigidlined cust fab two".
How much does Medicare pay for L0486?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $2,166.60–$3,711.93. Rural fees can be higher.
Does Medicare cover L0486?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0486 change in 2026?
The average non-rural state fee moved from $2,365.08 in 2025 to $2,412.38 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0486 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
- Run a reimbursement report for a device billed under L0486
- Watch L0486 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L0486
Sources: CMS HCPCS Level II release October 2026; 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.