Requirements for Coding Review of Custom Fabricated Spinal Orthoses

Effective for claims with dates of service on or after July 1, 2010, a custom fabricated LSO or TLSO made by a central fabrication facility or other entity that does not dispense directly to the beneficiary may be billed using code L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, or L0640 only if it has been submitted to the PDAC for Coding Verification Review. These code verified items must also be listed in the Product Classification List on the PDAC web site. 

A custom fabricated LSO / TLSO is one which is fabricated using molded-to-patient-model technique, CAD-CAM technology, or detailed measurements of the patient.

For coding verification, the supplier must submit written documentation that lists the spinal LSO or TLSO manufacturing processes and all components that will be a part of the base code for that particular spinal orthosis. In addition, the supplier must submit all of the following:

• HCPCS code recommendation
• Narrative description of the item to include but not limited to:
  1. Anatomical reference points
  2. Height of model used
  3. Length of panel(s)
  4. Materials used in fabrication process
  5. Photos of final product
• Company name and model name/number

Suppliers are reminded that for any questions regarding the correct coding of products to access the Durable Medical Equipment Coding System (DMECS) https://www4.palmettogba.com/pdac_dmecs/ or contact the Pricing, Data Analysis, and Coding (PDAC) Contact Center at 877-735-1326.