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See a sample rate comparisonHCPCS L1210 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Addition to Thoracic-lumbar-sacral-orthosis (TLSO), (low profile), lateral thoracic extension
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Low-profile Additions, Thoracic-lumbar-sacral Orthotics |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L1210 |
National average reimbursement for HCPCS L1210 by major payers:
$257.58
$173.72
$184.64
$349.52
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HCPCS L1210
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$539.24Published rateVictoria Lewis-Holland
$221.52Published rateKeck Medical Center Of Usc, Keck Hospital Of Usc
Keck Medical Center Of Usc
$196.44Published rateHospital Authority Of Jefferson County And The City Of Louisville, Jefferson Hospital
Hospital Authority Of Jefferson County And The City Of Louisville
$147.07Published rateWildwood Sanitarium, Incorporated, Wildwood Lifestyle Center And Hospital
Wildwood Sanitarium Incorporated
$98.04Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L1210 vs. Other Low-profile Additions, Thoracic-lumbar-sacral Orthotics Codes
The HCPCS L1210 code is part of the Orthotic Procedures and services services used for Low-profile Additions, Thoracic-lumbar-sacral 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 L1210 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 |
|---|---|---|
| L1200-HCPCS | High | Thoracic-lumbar-sacral-orthosis (TLSO), inclusive of furnishing initial orthosis only |
| L1210-HCPCS | Moderate | Addition to Thoracic-lumbar-sacral-orthosis (TLSO), (low profile), lateral thoracic extension |
| L1220-HCPCS | Moderate | Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior thoracic extension |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L1210. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L1210 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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