L1210 Lateral thoracic extensionAddition to tlso, (low profile), lateral thoracic extension
L1210 appears in 7 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Idiopathic Scoliosis (0398) MAGEC System | covered if criteria are met | Sep 28, 2026 | payer document |
| Aetna | Orthopedic Casts, Braces and Splints (0009) | covered if criteria are met (range L1000-L1499) | Jan 20, 2026 | payer document |
| Aetna | Orthopedic Casts, Braces and Splints (0009) | listed, no stance (range L1000-L1499) | 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 L1210-L1290) | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Interventions For Progressive Scoliosis | covered if criteria are met (range L1200-L1290) | payer document | |
| BlueCross BlueShield of South Carolina | Interventions for Progressive Scoliosis (CAM 20183) | listed, no stance (range L1000-L1499) | Jun 1, 2026 | payer document |
| Cigna | Orthotic Devices and Shoes (0543) | covered if criteria are met | Sep 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Interventions for Progressive Scoliosis (SUR705.046) HCPCS Codes L0999, L1000, L1005, L1010, L1020, L1025, L1030, L1040, L1050, L1060, | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in LA, MA, MS, NY, OH, VA.
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.