Re: cpt code for tlso brace?

[Guest guest]

Jill

I don't have the code but if it helps our Insurance considers it

Durable Medical equipment and I know that we had to go through the

Orthotic place that actually makes the brace to get the code. I

believe the Hospitals and docs are not the ones that do the billing

for the braces. It is intirely a different department in Denver that

we have to go through. It's just like if you go to the emergency room

you get an ER bill and a Physicians bill seperately for the different

services. I would ask the Secretary for the number of the company

they use for their orthotics and give them a call. Hope this helps

some.

Rochelle mom to Devyn 2 and 3/4yrs Infantile Scoliosis, Chiari 1

>

> Hello everyone,

> Does anyone know if there is a standard cpt code for the tlso

brace? Our insurance wants it and I do not have it. I asked my

doc's secretary, but she told me she doesn't have the specific code

for the brace just the name. It is the thoracolumbosacral orthosis

(TLSO for short). I called her back and left a message to please try

to locate it. If you know one that all the doc's use that would be

great. We are not in a brace yet, but I am trying to think

positively and be prepared.

>

> Also, is there anyone out there that has had the tlso brace after

casting and had it made in Rochester? Generally, how long does it

take to make the brace? Has anyone received it the same day?

> Thanks for any info,

> Jill and

>

[Guest guest]

Jill,

When Max had his first TLSO brace pre-casting the code used

was " L0482 " This was 2 years ago and the charge was $1872

(northcentral WI).

This past March, after his VEPTR surgery he had another TLSO made.

Teh code used was " L0486 " and the charge was $2117 (Chicago, IL).

Both were billed by the orthotic labs.

Hopefully this is a start for you.

Aekta

>

> Hello everyone,

> Does anyone know if there is a standard cpt code for the tlso

brace? Our insurance wants it and I do not have it. I asked my

doc's secretary, but she told me she doesn't have the specific code

for the brace just the name. It is the thoracolumbosacral orthosis

(TLSO for short). I called her back and left a message to please try

to locate it. If you know one that all the doc's use that would be

great. We are not in a brace yet, but I am trying to think

positively and be prepared.

>

> Also, is there anyone out there that has had the tlso brace after

casting and had it made in Rochester? Generally, how long does it

take to make the brace? Has anyone received it the same day?

> Thanks for any info,

> Jill and

>

[Guest guest]

OK That makes sense and helps so much. I will call tomorrow to get the brace makers number. How often do you think we will need to get a new brace? I will assume that when we get the brace the cost will be greater than when we "just" got the cast. I know every orthodist is different, but about how long is the turnaround usually?

Thanks for your insights.

jill

Subject: Re: cpt code for tlso brace?To: infantile_scoliosis Date: Monday, August 11, 2008, 6:35 PM

JillI don't have the code but if it helps our Insurance considers it Durable Medical equipment and I know that we had to go through the Orthotic place that actually makes the brace to get the code. I believe the Hospitals and docs are not the ones that do the billing for the braces. It is intirely a different department in Denver that we have to go through. It's just like if you go to the emergency room you get an ER bill and a Physicians bill seperately for the different services. I would ask the Secretary for the number of the company they use for their orthotics and give them a call. Hope this helps some.Rochelle mom to Devyn 2 and 3/4yrs Infantile Scoliosis, Chiari 1>> Hello everyone,> Does

anyone know if there is a standard cpt code for the tlso brace? Our insurance wants it and I do not have it. I asked my doc's secretary, but she told me she doesn't have the specific code for the brace just the name. It is the thoracolumbosacral orthosis (TLSO for short). I called her back and left a message to please try to locate it. If you know one that all the doc's use that would be great. We are not in a brace yet, but I am trying to think positively and be prepared.> > Also, is there anyone out there that has had the tlso brace after casting and had it made in Rochester? Generally, how long does it take to make the brace? Has anyone received it the same day? > Thanks for any info,> Jill and >

[Guest guest]

Wow Aekta,

I had no idea the braces were that expensive! Yikes. On average how often does a 2 and a a half year old need a new brace? I am thinking we may have to return to Shriner's if we need many braces.

Thanks for the codes. I will pass those along to insurance to get an idea of if they will pay. Did your insurance cover any of it? Are orthodic labs like hospitals in that some are in network and some are out of network?

Sorry so many questions. We may not even get a brace this time, but I hope soon.

How is Max doing after the VEPTR surgery?

Thanks tons

Jill

Subject: Re: cpt code for tlso brace?To: infantile_scoliosis Date: Monday, August 11, 2008, 7:34 PM

Jill, When Max had his first TLSO brace pre-casting the code used was "L0482" This was 2 years ago and the charge was $1872 (northcentral WI).This past March, after his VEPTR surgery he had another TLSO made. Teh code used was "L0486" and the charge was $2117 (Chicago, IL).Both were billed by the orthotic labs.Hopefully this is a start for you. Aekta>> Hello everyone,> Does anyone know if there is a standard cpt code for the tlso brace? Our insurance wants it and I do not have it. I asked my doc's secretary, but she told me she doesn't have the specific code for the brace just the name. It is the thoracolumbosacral orthosis (TLSO for short). I called her back and left a message

to please try to locate it. If you know one that all the doc's use that would be great. We are not in a brace yet, but I am trying to think positively and be prepared.> > Also, is there anyone out there that has had the tlso brace after casting and had it made in Rochester? Generally, how long does it take to make the brace? Has anyone received it the same day? > Thanks for any info,> Jill and >

[Guest guest]

The bottom of page 9 and page 10 list cpt codes for them here if that

helps...

http://www.cigna.com/customer_care/healthcare_professional/coverage_posi

tions/medical/mm_0113_coveragepositioncriteria_idiopathic_scoliosis.pdf

[Guest guest]

Jill

Devyn always had his new brace within a few days after they

molded except for the last time when one guy went on vacation and

there was mis-communication.It really depends on how fast the child

grows out of the brace as to how many you will need. Devyn needed a

new brace about every three months but he is a very big boy.He is two

and wears 4T clothes. Also each of our braces was at least $2500.00 a

piece which is cheaper than the cast because you don't have all the

anesthesia and doctor bills. Each cast devyn had was around $6000.00.

Rochelle

> >

> > Hello everyone,

> > Does anyone know if there is a standard cpt code for the tlso

> brace? Our insurance wants it and I do not have it. I asked my

> doc's secretary, but she told me she doesn't have the specific code

> for the brace just the name. It is the thoracolumbosacral orthosis

> (TLSO for short). I called her back and left a message to please

try

> to locate it. If you know one that all the doc's use that would be

> great. We are not in a brace yet, but I am trying to think

> positively and be prepared.

> >

> > Also, is there anyone out there that has had the tlso brace after

> casting and had it made in Rochester? Generally, how long does it

> take to make the brace? Has anyone received it the same day?

> > Thanks for any info,

> > Jill and

> >

>

[Guest guest]

Jill,I think it really depends on the child as to how often they need a new brace. has had the same brace since last September. And being that he is only in it now at night I think we may get a few more months out of it. We will go in September for a brace ck. is tall, but pretty slender. TashaMommy of twin boys- and 3 years oldFort Worth, Texas is 7.5 degrees and brace free during the day!!!Casting 14 months and bracing 10 months

From: babymaxpd <babymaxpdyahoo (DOT) com>Subject: [infantile_scoliosi s] Re: cpt code for tlso brace?To: infantile_scoliosis @yahoogroups. comDate: Monday, August 11, 2008, 7:34 PM

Jill, When Max had his first TLSO brace pre-casting the code used was "L0482" This was 2 years ago and the charge was $1872 (northcentral WI).This past March, after his VEPTR surgery he had another TLSO made. Teh code used was "L0486" and the charge was $2117 (Chicago, IL).Both were billed by the orthotic labs.Hopefully this is a start for you. Aekta>> Hello everyone,> Does anyone know if there is a standard cpt code for the tlso brace? Our insurance wants it and I do not have it. I asked my doc's secretary, but she told me she doesn't have the specific code for the brace just the name. It is the thoracolumbosacral orthosis (TLSO for short). I called her back and left a

message

to please try to locate it. If you know one that all the doc's use that would be great. We are not in a brace yet, but I am trying to think positively and be prepared.> > Also, is there anyone out there that has had the tlso brace after casting and had it made in Rochester? Generally, how long does it take to make the brace? Has anyone received it the same day? > Thanks for any info,> Jill and >

[Guest guest]

Jill

Also we have United Health care and Ameriben insurance. double

coverage both mine and my husbands. United Health Care only covers

2500.00 in Durable Medical Equipment a year but they did cover both

braces he had. It was 1200.00 that they covered after the contractual

discount then my husbands insurance picked up the rest. I also called

the insurance a requested a case manager to overlook all of Devyn's

claims to make sure they were taken care of. She took all the info on

his problems and prepared a report for the medical director to

dispute the claims so they would be covered. This may be something to

think about if your insurance won't cover a lot.

Rochelle

> > >

> > > Hello everyone,

> > > Does anyone know if there is a standard cpt code for the tlso

> > brace? Our insurance wants it and I do not have it. I asked my

> > doc's secretary, but she told me she doesn't have the specific

code

> > for the brace just the name. It is the thoracolumbosacral

orthosis

> > (TLSO for short). I called her back and left a message to please

> try

> > to locate it. If you know one that all the doc's use that would

be

> > great. We are not in a brace yet, but I am trying to think

> > positively and be prepared.

> > >

> > > Also, is there anyone out there that has had the tlso brace

after

> > casting and had it made in Rochester? Generally, how long does it

> > take to make the brace? Has anyone received it the same day?

> > > Thanks for any info,

> > > Jill and

> > >

> >

>

[Guest guest]

Jill,

Nothing comes without a cost these days.

Our insurance had no problem covering the braces or the VEPTR rods.

If you do return to Shriners they may still bill your insurance

company for the brace only. Max is a Shriners Chicago patient and

they billed out for his VEPTR rods and brace. Shriners did not bill

us for our coinsurance. I am very happy our insurance paid nearly

100% for VEPTR rods (we reached our out of pocket maximum). It's the

least Shriners can get for the services they have provided Max for

the past 2 years and perhaps the next 15 years.

When you call the insurance company, I would ask if there is a

frequency limit of how many braces can have per year/lifetime.

Atleast this will give you an idea of how you can budget in the

future.

Also, when you call ask your insurance company ask about the in/out

of network for the orthotic labs. Shriners will most likely be out of

network(if you go that route).

Thanks for asking about Max. He is doing fantastic. He has his first

expansion surgery on 8/25. We're a little nervous not knowing what to

expect with the first expansion. The firsts are always so hard, but

he's a great child who has always adjusted well thru his scoliosis

journey.He's getting use to water. He's very apprehensive, even with

baths, but every day gets easier.

Good luck.

Aekta

> >

> > Hello everyone,

> > Does anyone know if there is a standard cpt code for the tlso

> brace? Our insurance wants it and I do not have it. I asked my

> doc's secretary, but she told me she doesn't have the specific code

> for the brace just the name. It is the thoracolumbosacral orthosis

> (TLSO for short). I called her back and left a message to please

try

> to locate it. If you know one that all the doc's use that would be

> great. We are not in a brace yet, but I am trying to think

> positively and be prepared.

> >

> > Also, is there anyone out there that has had the tlso brace after

> casting and had it made in Rochester? Generally, how long does it

> take to make the brace? Has anyone received it the same day?

> > Thanks for any info,

> > Jill and

> >

>