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L0456 Service Type Codes to Send

HCPCS code

Orthotics (braces and supports)

CMS description

Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Why these codes

5010 has no orthotics code; payers answer braces under DME, some under prosthetic devices.

If a payer returns nothing

Payers don't all answer every service type. Send 30 (Health Benefit Plan Coverage) for the plan's general benefits.

Sources

CMS HCPCS Level II descriptor; X12 HIPAA 5010 service type code definitions; VerifyTX billing practice

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