CMS Announces New TLSO K-Codes

The Centers for Medicare & Medicaid Services (CMS) has announced two new K-Codes for TLSOs to go into effect July 1, noted the American Orthotic & Prosthetic Association (AOPA) and the National Association for the Advancement of Orthotics & Prosthetics (NAAOP).

The codes are:

K0618: TLSO, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment.

K0619: TLSO, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment.

These new codes, since they are for prosthetic devices, will not be subject to home health consolidated billing, but will be subject to SNF [skilled nursing facility] billing, according to CMS.

AOPA said in an Internet post that, according to the staff of the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC), the new temporary codes do not target any specific devices, but were created to fill some "holes" in the list of new TLSO codes released January 1.

NAAOP noted that additional information can be found at http://www.cms.hhs.gov/manuals/pm_trans/ab03045.pdf.