Spinal Orthoses: TLSO and LSO
National · Effective Jan 1, 2020
1 active Medicare policy lists L0454, and 3 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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National · Effective Jan 1, 2020
3 policies from 3 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of L0454 |
|---|---|---|
| Durable Medical Equipment and Orthotics and Prosthetics Guidelines | Not recorded | Covered |
| Policy | Effective | Status of L0454 |
|---|---|---|
| CG-OR-PR-06 Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Oct 1, 2025 | Covered |
| Policy | Effective | Status of L0454 |
|---|---|---|
| Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Jul 1, 2026 | Covered |