Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 1 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L0720
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $2,220.69 to $2,381.24 in the contiguous states; $2,332.36 to $2,437.98 in AK, HI, PR and VI
Payer policies and prior authorization for L0720
20 of 20 payer prior-auth lists that name L0720 require prior authorization or set conditions: CarePlus Health Plans, Humana, Medicare, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Texas, Passport by Molina Healthcare (Kentucky).
Payer
Plan
State
Prior auth
Conditions
Since
Source
Medicare
DMEPOS Probationary Prior Authorization (new suppliers)
All
prior auth under conditions
Newly enrolled or changed-ownership suppliers in their probationary year
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.