June 2001 Bulletin

HCFA tells new cast codes

By Margie Scalley Vaught

HCFA has released the new cast/splint supplies codes that were mentioned in the Nov 1, 2000 Federal Register. Effective July 1, 2001, the previous HCPCS codes of A4570, A4580 and A4590 will no longer be valid when billing for cast/splint materials associated with fractures and/or dislocations.

Since the 2001 Physician’s Fee schedule adjusted the RVU value in the practice expense to reflect these codes, offices might have seen a decrease in their reimbursement for fracture/dislocation care codes (29000-29590). HCFA instructs that the work and practice expenses involved in the application of the cast and/or splint should continue to be coded using the appropriate CPT code (29000-29590).

These new codes are Q4001-Q4048 and are cross-walked to the applications codes. Such as code 29365 Application of cylinder cast (thigh to ankle) could be linked to Q4034 Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass, which is reimbursed at $47.65. There are four cast material codes for some cast application codes–one for plaster, for fiberglass, for adult and for child. So offices will need to have further information from the provider in order to select the appropriate HCPCS code.

Program Memorandum AB-01-60 states "Codes A4570, A4580, A4590, L2102, L2104, L2122, and L2124, which were previously used for billing of splints and casts (materials) are invalid for Medicare use effective July 1, 2001, for carrier processed claims and October 1, 2001, for intermediary processed claims. Carriers should allow for a three-month grace period (July 1 through Sept. 30, 2001) for use of these codes while transitioning to the new Q codes for splints and casts."

HCFA further stated for clarification: "To assist physicians and practitioner to select the correct code for the cast and splinting supplies, the following crosswalk provides guidance as to which supply codes are applicable for the various types of casts described by Level I or CPT codes."

Payment for claims for miscellaneous splints and casts (Q4050 and Q4051) shall be determined by the carrier based upon their individual consideration for each item.

The Program Memo AB-01-60 is at http://www.hcfa.gov/pubforms/transmit/ab0160.pdf

Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.