June 2001 Bulletin

HCFA tells new cast codes

Q4001—Q4048 for supplies are cross-walked to application 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."

Margie Scalley Vaught, CPC, is an independent coding specialist in Ellensburg, Wash. She also is a member of the American Academy of Professional Coders National Advisory Board.

CPT

HCPCS

HCPCS

Payment Amount

29000

Q4001 or Q4002

A4565

$6.10

29010

Q4001 or Q4002

Q4001

$34.78

29015

Q4001 or Q4002

Q4002

$131.44

29020

Q4001 or Q4002

Q4003

$24.98

29025

Q4001 or Q4002

Q4004

$86.48

29035

Q4001 or Q4002

Q4005

$9.21

29040

Q4001 or Q4002

Q4006

$20.76

29044

Q4001 or Q4002

Q4007

$4.61

29046

Q4001 or Q4002

Q4008

$10.38

29049

Q4050

Q4009

$6.14

29055

Q4003 or Q4004

Q4010

$13.84

29058

Q4003

Q4011

$3.07

29065

Q4005 through Q4008

Q4012

$6.92

29075

Q4009 through Q4012

Q4013

$11.18

29085

Q4013 through Q4016

Q4014

$18.88

29105

Q4017 through Q4020

Q4015

$5.59

29125

Q4021throughQ4024

Q4016

$9.44

29126

Q4021 through Q4024

Q4017

$6.47

29130

Q4049

Q4018

$10.32

29131

Q4051

Q4019

$3.24

29305

Q4025 through Q4028

Q4020

$5.16

29325

Q4025 through Q4028

Q4021

$4.79

29345

Q4029 through Q4032

Q4022

$8.64

29355

Q4029 through Q4032

Q4023

$2.40

29365

Q4033 through Q4036

Q4024

$4.32

29405

Q4037 through Q4040

Q4025

$26.86

29425

Q4037 through Q4040

Q4026

$83.85

29435

Q4037 through Q4040

Q4027

$13.43

29440

Q4050

Q4028

$41.93

29445

Q4037 through Q4040

Q4029

$20.53

29450

Q4035, Q4036, Q4039, or Q4040

Q4030

$54.05

29505

Q4041 through Q4044

Q4031

$10.27

29515

Q4045 through Q4048

Q4032

$27.03

Q4033

$19.15

Q4034

$47.65

Q4035

$9.58

Q4036

$23.83

Q4037

$11.69

Q4038

$29.27

Q4039

$5.85

Q4040

$14.64

Q4041

$14.21

Q4042

$24.25

Q4043

$7.10

Q4044

$12.13

Q4045

$8.25

Q4046

$13.27

Q4047

$4.12

Q4048

$6.64

Q4049

$1.50

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.


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