Question 1

What is HCPCS code L0469?

Accepted Answer

HCPCS code L0469 is "Tlso rig fram pelvic pre ots". 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, off-the-shelf

Question 2

What category is L0469 in?

Accepted Answer

L0469 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L0469?

Accepted Answer

Use L0469 when billing for tlso rig fram pelvic pre ots. 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 L0469 covered by Medicare?

Accepted Answer

Coverage for L0469 (Tlso rig fram pelvic pre ots) 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 L0469?

Accepted Answer

Documentation for L0469 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).