L1200 HCPCS code: Thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only
L1200 is the HCPCS Level II code for thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only. The 2026 Medicare DMEPOS fee schedule pays $1,800.47 to $3,428.48 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 fell 34% from 2022 to 2024 (47 to 31 services). In 2024, 28 suppliers billed Medicare for L1200 (purchases), serving 31 beneficiaries. Its average fee ranks 10 of 10 L12 codes (family range $94.70–$2,126.94).
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 | 1986-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L1200
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,800.47 | $3,428.48 | $2,400.62 | $1,800.47 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3,206.24 | — |
| AL | — | $1,997.03 | — |
| AR | — | $2,070.70 | — |
| AZ | — | $2,400.62 | — |
| CA | — | $2,400.62 | — |
| CO | — | $2,159.12 | — |
| CT | — | $2,137.23 | — |
| DC | — | $1,800.47 | — |
| DE | — | $1,800.47 | — |
| FL | — | $1,997.03 | — |
| GA | — | $1,997.03 | — |
| HI | — | $3,428.48 | — |
| IA | — | $2,085.29 | — |
| ID | — | $2,400.62 | — |
| IL | — | $2,199.24 | — |
| IN | — | $2,199.24 | — |
| KS | — | $2,085.29 | — |
| KY | — | $1,997.03 | — |
| LA | — | $2,070.70 | — |
| MA | — | $2,137.23 | — |
| MD | — | $1,800.47 | — |
| ME | — | $2,137.23 | — |
| MI | — | $2,199.24 | — |
| MN | — | $2,199.24 | — |
| MO | — | $2,085.29 | — |
| MS | — | $1,997.03 | — |
| MT | — | $2,159.12 | — |
| NC | — | $1,997.03 | — |
| ND | — | $2,159.12 | — |
| NE | — | $2,085.29 | — |
| NH | — | $2,137.23 | — |
| NJ | — | $1,800.47 | — |
| NM | — | $2,070.70 | — |
| NV | — | $2,400.62 | — |
| NY | — | $1,800.47 | — |
| OH | — | $2,199.24 | — |
| OK | — | $2,070.70 | — |
| OR | — | $2,400.62 | — |
| PA | — | $1,800.47 | — |
| PR | — | $1,840.48 | — |
| RI | — | $2,137.23 | — |
| SC | — | $1,997.03 | — |
| SD | — | $2,159.12 | — |
| TN | — | $1,997.03 | — |
| TX | — | $2,070.70 | — |
| UT | — | $2,159.12 | — |
| VA | — | $1,800.47 | — |
| VI | — | $1,800.47 | — |
| VT | — | $2,137.23 | — |
| WA | — | $2,400.62 | — |
| WI | — | $2,199.24 | — |
| WV | — | $1,800.47 | — |
| WY | — | $2,159.12 | — |
How the L1200 fee compares
| Measure | Value |
|---|---|
| Rank among 10 L12 codes (lowest = 1) | 10 |
| Family fee range (average of state fees) | $94.70–$2,126.94 |
| Rural fee uplift | — |
Who bills L1200 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 28 |
| Referring clinicians | 31 |
| Medicare beneficiaries | 31 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 33 | 47 |
| 2023 | 26 | 28 |
| 2024 | 28 | 31 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L1200, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 47 | 47 | $1,855.03 | $1,457.76 |
| 2023 | 29 | 28 | $2,062.63 | $1,617.10 |
| 2024 | 31 | 31 | $2,135.87 | $1,660.61 |
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 L1200
- 2026-01-01: Average state fee rose 2.0%: $2,085.23 to $2,126.94
- 1986-01-01: L1200 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 L1200?
L1200 is the HCPCS Level II code for thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only. Short descriptor: "Furnsh initial orthosis only".
How much does Medicare pay for L1200?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,800.47–$3,428.48. Rural fees can be higher.
Does Medicare cover L1200?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L1200 change in 2026?
The average non-rural state fee moved from $2,085.23 in 2025 to $2,126.94 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1200 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L12 codes
- L1210 — Addition to tlso, (low profile), lateral thoracic extension ($300.68–$621.52)
- L1220 — Addition to tlso, (low profile), anterior thoracic extension ($254.58–$641.16)
- L1230 — Addition to tlso, (low profile), milwaukee type superstructure ($653.22–$1,144.60)
- L1240 — Addition to tlso, (low profile), lumbar derotation pad ($83.25–$148.00)
- L1250 — Addition to tlso, (low profile), anterior asis pad ($63.89–$111.79)
- L1260 — Addition to tlso, (low profile), anterior thoracic derotation pad ($63.89–$123.28)
- L1270 — Addition to tlso, (low profile), abdominal pad ($73.54–$166.30)
- L1280 — Addition to tlso, (low profile), rib gusset (elastic), each ($99.14–$167.07)
- L1290 — Addition to tlso, (low profile), lateral trochanteric pad ($75.46–$234.03)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L1200
- Watch L1200 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1200
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.