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See a sample rate comparisonHCPCS L0486 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Thoracic-lumbar-sacral (TLSO) Orthotics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L0486 |
National average reimbursement for HCPCS L0486 by major payers:
$1,912.99
$1,237.95
$1,319.39
$2,887.10
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HCPCS L0486
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$5,180.76Published ratePhoebe Putney Memorial Hospital Inc, Phoebe Putney Memorial Hosptial
Phoebe Physician Group Inc
$1,388.77Published rateEffingham Hospital, Inc., Effingham Health System
Effingham Hospital Inc
$1,015.46Published rateProfessional Resources Management Of Rabun, LLC, Mountain Lakes Medical Center
$922.53Published rateKristina Jimenez
Miguel A Arenas Md PC
$706.46Published rate
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See a sample payer proposalHCPCS L0486 vs. Other Thoracic-lumbar-sacral (TLSO) Orthotics Codes
The HCPCS L0486 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 L0486 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.
| Code | Complexity | Description |
|---|---|---|
| L0484-HCPCS | High | 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 |
| L0486-HCPCS | High | Thoracic-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 |
| L0488-HCPCS | High | Thoracic-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, prefabricated, includes fitting and adjustment |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L0486. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L0486 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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