What is the price of a scoliosis TLSO brace?
If you want the quick answer, we will tell you that the price can range from $1324 – $2108.00. This is a common price range that we see. This is also the cost of the brace if you had to pay out of pocket, which many folks do not have to do.
If you want a more complete answer, please read on.
Our goal is to help you get the answer you are looking for with this article. You might be wondering, why did the author give a range to me? The truth is, that there is not just “one cost”, so we have to approach this in a different way. We realize that it would be ideal to just get one cost and be done with it, but then we would be actually be doing you a disservice.
We intend to give you a cost that shows you how the price can actually vary dependent on a few variables. There are not a ton of different variables, but a few do exist.
We can help to get you very close to what the price should be, but you have to know that the type of insurance you have, the deductible in your plan and variations in brace type matter when it comes to your bottom line with scoliosis brace pricing. Therefore, we have to tell you these prices are educated approximations.
If you see a scoliosis brace specialist (which we recommend), called an orthotist this will get you the best outcome possible to treat the diagnosis.
Why do we say this?
These individuals have to go through rigourous schooling and a residency program just to be able to treat your son or daughter. Moreover, they have to pass state boards etc. Secondly, you do not have to come to our company, there are many orthotists that you can choose from. This way you can be more comfortable knowing we are not in it for the money to tell you to see this type of professional.
These brace specialists are bound to a set of billing principles that use something called hcpc codes. The Health Care Procedure Coding System. – In specific, the codes assigned to scoliosis braces are “L codes”. We will list the most common ones below, but know there are more, but they are not common in our experience.
The most common codes that are assigned to a scoliosis tlso are as follows. Please note that the orthotist does not make up the cost for these codes, as they are predetermined :
L 1200 : Scoliosis – Thoracic-Lumbar Sacral (Low Profile TLSO), inclusive of furnishing initial orthosis only. = $1718.00
L1210 : Addition to TLSO, (low profile); lateral thoracic extension = $188.00
L1240 : Lumbar derotation pad = $70.00
L 1260 : Anterior thoracic derotation pad = $72.00
L 1290 : Lateral trocanteric pad = $60.00
L1300 : Other scoliosis procedure; body jacket molded to patient model = $1324.00
You typically will not be billed for an L1200 and a L1300. You can see they are different dollar amounts. We can also not tell you which one your son or daughter should get unless we treated them. But, we can tell you that every add on code is not necessarily needed either. Codes L1290 and L1210 are for decompensation of the spine, which your son or daughter may or may not have. This means that their spine can not only be curving, but the top and bottom are off center. Meaning it is shifted to the right or left of center.
In addition, for example, the pads for L1240 and L1260 might not both be required. Usually one is used however, at the least. It is up the curve type of your son or daughter. The more intense the curve the need for potentially more pads. The shape of the curve also comes into play here.
These are the codes though that the orthotist has to basically consider when billing your insurance for reimbursement.
But, here’s the catch…
Each insurance and each separate insurance plan within each brand name has a different rate of reimbursement. If your orthotist has signed up with most insurances plans (which is typically what they try to do), then they are bound to the insurance plan’s reimbursement for a particular code, for example. (Some insurance plans do not want to let new orthotic companies in so they do not have to pay the in network price, FYI. Just a side note to consider…. )
So, this is just one way the price can vary on your child’s scoliosis tlso brace.
We gave you the price dictated to us by an insurance plan we are in network with. So, on the low end you are APPROXIMATELY looking at $1324.00 and this price could find its way up to $2108.00 depending on add on codes that are required. I can see why that price could be justified depending on the situation. There are other codes for a gusset, or a milwaukee superstructure, for example. These codes that could tag on another $600 approximately, but these are not commonly used in our experience.
So there you have it : $1324 – $2108.00 depending. This is the most common price range that we see as a prosthetic and orthotic practice. But reimbursement amounts go up and down, so please do not be upset with us if those numbers move a little bit.
Having said all of this, you could still owe nothing when your son or daughter gets a scoliosis TLSO. If your deductible has been met, then you you might owe whatever your deductible is too. This part depends.
Now, if you do not have the brace billed to insurance, because you might not have it then the numbers game can change somewhat. An ethical provider should have you somewhere close to this range though, in most cases if you are paying cash.
Unless, like we said earlier, your child needs a gusset or a superstructure, or ASIS pads for example. The superstructure these days is extremely rare. Studies show compliance would reduce and skin break down would happen at the chin with this add on. The other codes are not common in our experience either for scoliosis TLSOs.
We all have to remember we treat the diagnosis and the child. If the child does not want to wear the brace because it has a neck superstructure, then the parent and child will suffer to the point where compliance will definitely be challenged.
Just know that if you are paying cash for a brace then at least you now have a range for the cost.
We hope this article has been helpful for you. Our whole intention is to help you find out more about pricing. But, now you can see the price can vary and at least you have a base to work from when calculating your costs.
Check out our other blog posts as well on scoliosis and other forms of prosthetic and orthotic treatment.
*Rinella Prosthetics & Orthotics, Inc can not be responsible if you are quoted another price from a different vendor. Unless we are directly involved in the care for your son or daughter, we have no say in the final bill you may or may not receive.