Question 1

What is HCPCS code L0470?

Accepted Answer

HCPCS code L0470 is "Tlso rigid frame pre subclav". Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

Question 2

What category is L0470 in?

Accepted Answer

L0470 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L0470?

Accepted Answer

Use L0470 when billing for tlso rigid frame pre subclav. 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 L0470 covered by Medicare?

Accepted Answer

Coverage for L0470 (Tlso rigid frame pre subclav) 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 L0470?

Accepted Answer

Documentation for L0470 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).