Skip to Main Content

Print | Bookmark | Email | Font Size: + |

March 22, 2018

Billing Instructions – LSO and TLSO

Joint DME MAC Publication

The DME MACs have claims data showing that spinal orthoses are often replaced at a frequency greater than the allowed 5-year reasonable useful lifetime (RUL). Most commonly replacement is with an orthosis described by a different Healthcare Common Procedure Coding System (HCPCS) code than was originally billed. Suppliers are reminded that unless otherwise specified, an item of durable medical equipment, prosthetics or orthotics has a RUL of five (5) years. It the item is lost, stolen, irreparably damaged or there is a change in medical necessity, replacement may be provided sooner than the 5-year RUL.

To avoid claim denials for RUL, suppliers must note in the narrative field on the claim the reason necessitating the early replacement of the same HCPCS code or substitution of a similar HCPCS coded spinal orthosis for the HCPCS code originally billed. Suppliers must maintain this information in their files and make it available upon request. This applies to the following spinal orthosis codes:

L0450 L0452 L0454
L0455 L0456 L0457
L0458 L0460 L0462
L0464 L0466 L0467
L0468 L0469 L0470
L0472 L0480 L0482
L0484 L0486 L0488
L0490 L0491 L0492
L0621 L0622 L0623
L0624 L0625 L0626
L0627 L0628 L0629
L0630 L0631 L0632
L0633 L0634 L0635
L0636 L0637 L0638
L0639 L0640 L0641
L0642 L0643 L0648
L0649 L0650 L0651

Refer to the Spinal Orthoses LCD (L33790External Website), related Policy Articles (A52500External Website and A55426External Website) on the DME MAC web sites and the CMS Medicare Coverage Database for additional coverage, coding, and documentation requirements.

Publication History
March 22, 2018 Original publication

Reviewed: 12.30.2022

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved