Question 1

What is HCPCS code L0468?

Accepted Answer

HCPCS code L0468 is "Tlso rig fram pelvic pre cst". Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Question 2

What category is L0468 in?

Accepted Answer

L0468 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L0468?

Accepted Answer

Use L0468 when billing for tlso rig fram pelvic pre cst. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L0468 covered by Medicare?

Accepted Answer

Coverage for L0468 (Tlso rig fram pelvic pre cst) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L0468?

Accepted Answer

Documentation for L0468 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).