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HCPCS L0484 Fee Schedule

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, two piece rigid plastic shell without interface liner, with 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
Key FactDetail
Service Type

Orthotic Procedures and services

Thoracic-lumbar-sacral (TLSO) Orthotics

Complexity LevelHigh
Medicaid Fee ScheduleView Medicaid rates for L0484

National average reimbursement for HCPCS L0484 by major payers:

bcbs

$1,827.09

uhc

$1,179.51

aetna

$1,252.51

cigna

$2,591.28

Compare published rates across providers.

Choose a payer to see a sample of rates for HCPCS L0484.

HCPCS L0484
5 of 25 sample ratesHigher to lower in this preview
  1. Chu Chen

    Merrimack Valley Pediatric Associates, Inc.

    MAPediatrics PhysicianNPI 1073502985Tax ID 42-484572

    $4,883.14Published rate
  2. Ujuka Iloabuchi

    GAWomen's HospitalNPI 1306136551Tax ID 88-1014763

    $2,372.35Published rate
  3. Ujuka Iloabuchi

    Atlanta Womens Health Group, P.C.

    GAWomen's HospitalNPI 1306136551Tax ID 58-2422542

    $1,069.72Published rate
  4. Cindy Chang

    Miguel A Arenas Md PC

    AZFamily Nurse PractitionerNPI 1316561236Tax ID 30-0394179

    $954.28Published rate
  5. Miguel A. Arenas, M.D., PC

    Miguel A Arenas Md PC

    AZGastroenterology PhysicianNPI 1053515130Tax ID 30-0394179

    $665.88Published rate

National sample. Rates vary by location, specialty, and contract.

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Payer Contract Negotiation

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HCPCS L0484 vs. Other Thoracic-lumbar-sacral (TLSO) Orthotics Codes

The HCPCS L0484 code is part of the Orthotic Procedures and services services used for Thoracic-lumbar-sacral (TLSO) Orthotics. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS L0484 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
L0482-HCPCSHighThoracic-lumbar-sacral orthosis (TLSO), triplanar control, one 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, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
L0484-HCPCSHighThoracic-lumbar-sacral orthosis (TLSO), triplanar control, two piece rigid plastic shell without interface liner, with 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-HCPCSHighThoracic-lumbar-sacral orthosis (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

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L0484. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the L0484 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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