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See a sample rate comparisonHCPCS L1250 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), anterior asis pad
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Low-profile Additions, Thoracic-lumbar-sacral Orthotics |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for L1250 |
National average reimbursement for HCPCS L1250 by major payers:
$79.02
$50.49
$57.25
$112.36
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HCPCS L1250
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$173.84Published ratePhoebe Putney Memorial Hospital Inc, Phoebe Putney Memorial Hosptial
Phoebe Putney Memorial Hospital Inc
$70.94Published rateEffingham Hospital, Inc., Effingham Health System
Effingham Hospital Inc
$51.88Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$47.13Published rateKarlie Ryan
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$40.61Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L1250 vs. Other Low-profile Additions, Thoracic-lumbar-sacral Orthotics Codes
The HCPCS L1250 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 L1250 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 |
|---|---|---|
| L1240-HCPCS | Low | Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad |
| L1250-HCPCS | Low | Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior asis pad |
| L1260-HCPCS | Low | Addition to Thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior thoracic derotation pad |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L1250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L1250 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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