`L0972` Lso corset front

Lso, corset front

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 L0972

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, prosthetics and orthotics (PO): non-rural $118.26 to $157.68 in the contiguous states; $81.66 to $198.16 in AK, HI, PR and VI; ceiling $157.68, floor $118.26

Payer policies and prior authorization for L0972

Payer coverage policies that name L0972

L0972 appears in 4 coverage policies from Aetna, Anthem, Cigna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Back Pain - Invasive Procedures (0016)	listed, no stance (range L0112-L0999)	Oct 6, 2026	payer document
Aetna	Orthopedic Casts, Braces and Splints (0009)	covered if criteria are met (range L0970-L0999)	Jan 20, 2026	payer document
Anthem	Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar (CG-OR-PR-06)	covered if criteria are met (range L0970-L0982)	Feb 19, 2026	payer document
Cigna	Orthotic Devices and Shoes (0543)	covered if criteria are met	Sep 15, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in LA, MA, MS, NY, OH, VA, WA, WV.

AZ: $132.10 (dme), effective Oct 1, 2026
CO: $72.66 (chp_plus, non-facility), effective Jul 1, 2026
FL: $52.04 (dme), effective Jul 1, 2026
IL: $69.50 (dme), effective Jan 1, 2026
IN: $99.62 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $96.20 (default), effective Jul 1, 2026
KY: $83.88 (dme), effective Jan 1, 2026
LA: $82.93 (dme), effective Jul 1, 2012
MA: $90.50 (orthotics_prosthetics_rates), effective Apr 1, 2024
MD: $117.97 (dme), effective Apr 1, 2026
MS: $107.40 (comprehensive), effective Jul 1, 2026
ND: $142.42 (dme), effective Aug 1, 2026
NE: $103.26 (dme), effective Jul 1, 2026
NY: $40.40 (dme), effective Jul 1, 2026
OH: $62.14 (dme), effective Jan 1, 2010
OK: $106.94 (dme), effective Jan 1, 2026
TX: $91.26 (dmepos_tos_9_e_j_l_and_r, Hospital - Long Term, Limited, Or Specialized Ca, facility), effective Apr 1, 1992
VA: $124.91 (dme), effective Dec 1, 2026
VT: $99.13 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $88.89 (prosthetics_orthotics), effective Jul 1, 2026
WY: $80.91 (professional), effective Jan 1, 2021

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.

L0972 Lso corset front