Benefit Payment Guideline
Casting and Dressing Application
Benefit Policy Statement:
The use of casting, splinting or strapping may be considered medically necessary for a patient who has experienced
a fracture, dislocation or who has ligamentous instability following an acute injury, or as the result of a disease or
surgery.
HealthyCT covers and considers for reimbursement cast and dressing applications and associated supplies
provided in the office setting.
_______________________________________________________________________________________________________________________
Benefit Policy Guidelines:
Application of casts and dressings is covered after the applicable Cost-Share amount. The Cost-Share amount
depends on where the services are provided.
Supplies that are used for recasting or re-splinting are eligible for separate reimbursement when the service is
performed in the office setting by an orthopedist, internist, podiatrist, pediatrician, general practitioner, family
practitioner, or primary care practitioner (PCP).
LOB:
Commercial – On exchange and off exchange
☒Large group
☒Small group
☒Individual
Provider Guidelines:
Initial Application
1.
The initial application of a cast or splint is eligible for separate reimbursement from the evaluation and
management service (E/M), except when the initial application is associated with fracture care or follows
surgery. In such cases, the initial application and the E/M are included in the surgical fee.
Proprietary and Confidential
Benefit Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This
Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and
therefore is subject to change.
Casting and Dressing Application: Approved at 8/8/2014 PCP committee meeting
2. Additional evaluation and management services are reportable only if significant identifiable further
services are provided at the time of the cast application or strapping. In these cases, further review of a
claim and supporting documentation may be necessary to make the appropriate reimbursement decision.
Reapplication and supplies
1. The professional component for the reapplication of a cast or splint is eligible for separate reimbursement
from the E/M when provided in the office setting, with the following exception:
• When the reapplication of a cast or splint follows a surgical procedure or fracture care, the
professional component is considered part of the surgical fee and is not eligible for separate
reimbursement
Removal or Repair
1. Codes for cast removals should be only used for casts applied by another individual. If the cast was applied
by the same practitioner, the codes for removal should not be billed. This is because the codes in the
“Application of Casts and Strapping” series include the cast removal as well as the application.
Code Description:
See Attachment A for list of applicable codes*
The following HCPCS Level II category A codes represent general codes and should not be reported because there
are specific codes in the HCPCS level II categories (i.e.: E-codes, L-codes, and Q-codes) for splints and casting
supplies. This is consistent with CMS correct coding guidelines.
• Splints – A4570
• Cast supplies (e.g.: plaster) – A4580
•
Special casting material (e.g.: fiberglass) – A4590
Examples of Claim Adjudication Scenarios:
Example 1: Member seen by PCP in office with an injury to her finger. After evaluating Member the practitioner
decides the patient has a sprained intraphalangeal joint and applies a splint to the patient’s finger. Appropriate to
bill the initial splinting code along with an E&M code and the appropriate Q code.
Example 2: An emergency room practitioner examines a patient who reports with a closed humeral shaft fracture.
The patient is also complaining of a headache and chest pain. The practitioner treats the arm but also conducts a
Proprietary and Confidential
Benefit Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This
Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and
therefore is subject to change.
Casting and Dressing Application: Approved at 8/8/2014 PCP committee meeting
level–four E/M service to determine the cause of the head and chest pain. The fracture care code and the E/M
code (with the appropriate modifier _25) should be paid separately.
Example 3: Emergency Room Visit-A patient is diagnosed with an ankle fracture in the emergency department. The
practitioner applies a short leg cast and refers the patient to an orthopedist. If the practitioner applies the cast,
Report the code for the application of the cast. If the hospital staff applies the cast, the facility will report the same
code. The facility should also charge for the supply, as appropriate.
Example 4: Orthopedic Visit-The same patient presents to the orthopedist for definitive treatment. Closed
reduction with manipulation is performed and a cast applied. The practitioner should report the CPT code for closed
treatment of the fracture only, because cast application is integral to any definitive fracture treatment. The
practitioner may report supplies with the appropriate Q codes.
Example 5: Follow-up Visit: The same patient then returns to the same practitioner, who removes the cast. The
practitioner may not report the removal of cast, because the removal by the same practitioner or a practitioner in
the same practitioner group is included in the application code. The removal of cast codes may only be assigned
when a different practitioner in a different practitioner group removes the cast.
Exclusions
N/A (except those listed in the Provider guidelines)
References
•
•
•
AMA CPT
Certificate of Coverage
Nelson, Tanai S.; Benjamin, Christina. "Casting Conundrum: Correct Coding for Casts, Splints, and Strapping "
Journal of AHIMA 80, no.7 (July 2009): 74-76.
Document History
8/8/2014
Initial Version
Proprietary and Confidential
Benefit Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This
Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and
therefore is subject to change.
Casting and Dressing Application: Approved at 8/8/2014 PCP committee meeting
Attachment A
Casting and Dressing Application Benefit Guidelines
CPT CODES
Cast Application:
29010, 29015, 29020, 29025, 29035, 29040, 29044, 29046, 29049, 29055, 29058, 29065, 29075,
29085, 29086, 29305, 29325, 29345, 29355, 29358, 29365, 29405, 29425, 29435, 29440, 29445,
29450
Splint Application:
29105, 29125, 29126, 29130, 29131, 29505, 29515
Strapping Applications:
29520, 29530, 29540, 29550, 29580, 29581, 29200, 29240, 29260, 29280
Removal and Repair:
29700, 29705, 29710, 29715, 29720, 29730, 29740, 29750, 29799
Cast and Splint Supplies:
Codes
Narrative Description
Q4001
Casting supplies, body cast adult, with or without head, plaster
Q4004
Cast supplies, shoulder cast, adult (11 years +), fiberglass
Q4002
Q4003
Q4005
Q4006
Q4007
Q4008
Q4009
Q4010
Q4011
Cast supplies, body cast adult, with or without head, fiberglass
Cast supplies, shoulder cast, adult (11 years +), plaster
Cast supplies, long arm cast, adult (11 years +), plaster
Cast supplies, long arm cast, adult (11 years +), fiberglass
Cast supplies, long arm cast, pediatric (0-10 years), plaster
Cast supplies, long arm cast, pediatric (0-10 years), fiberglass
Cast supplies, short arm cast, adult (11 years +), plaster
Cast supplies, short arm cast, adult (11 years +), fiberglass
Cast supplies, short arm cast, pediatric (0-10 years), plaster
Q4012
Cast supplies, short arm cast, pediatric (0-10 years), fiberglass
Q4014
Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +),
fiberglass
Q4013
Q4015
Q4016
Q4017
Q4018
Q4019
Q4020
Q4021
Q4022
Q4023
Q4024
Q4025
Q4026
Q4027
Q4028
Q4029
Q4030
Q4031
Q4032
Q4033
Q4034
Q4035
Q4036
Q4037
Q4038
Q4039
Q4040
Q4041
Q4042
Q4043
Q4044
Q4045
Q4046
Q4047
Q4048
Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster
Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years),
plaster
Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years),
fiberglass
Cast supplies, long arm splint, adult (11 years +), plaster
Cast supplies, long arm splint, adult (11 years +), fiberglass
Cast supplies, long arm splint, pediatric (0-10 years), plaster
Cast supplies, long arm splint, pediatric (0-10 years), fiberglass
Cast supplies, short arm splint, adult (11 years +), plaster
Cast supplies, short arm splint, adult (11 years +), fiberglass
Cast supplies, short arm splint, pediatric (0-10 years), plaster
Cast supplies, short arm splint, pediatric (0-10 years), fiberglass
Cast supplies, hip spica (one or both legs), adult (11 years +), plaster
Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass
Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster
Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass
Cast supplies, long leg cast, adult (11 years +), plaster
Cast supplies, long leg cast, adult (11 years +), fiberglass
Cast supplies, long leg cast, pediatric (0-10 years), plaster
Cast supplies, long leg cast, pediatric (0-10 years), fiberglass
Cast supplies, long leg cylinder cast, adult (11 years +), plaster
Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass
Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster
Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass
Cast supplies, short leg cast, adult (11 years +), plaster
Cast supplies, short leg cast, adult (11 years +), fiberglass
Cast supplies, short leg cast, pediatric (0-10 years), plaster
Cast supplies, short leg cast, pediatric (0-10 years), fiberglass
Cast supplies, long leg splint, adult (11 years +), plaster
Cast supplies, long leg splint, adult (11 years +), fiberglass
Cast supplies, long leg splint, pediatric (0-10 years), plaster
Cast supplies, long leg splint, pediatric (0-10 years), fiberglass
Cast supplies, short leg splint, adult (11 years +), plaster
Cast supplies, short leg splint, adult (11 years +), fiberglass
Cast supplies, short leg splint, pediatric (0-10 years), plaster
Cast supplies, short leg splint, pediatric (0-10 years), fiberglass
Q4049
Finger splint, static
S8450
Splint, prefabricated, digit (Specify digit by use of modifier)
Q4050
Q4051
S8451
S8452
Cast supplies, for unlisted types and materials of casts
Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding
and other supplies)
Splint, prefabricated, wrist or ankle
Splint, prefabricated, elbow
Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions,
precertification/referral requirements, provider contracts, and Company policies apply.
The codes listed above are updated on a regular basis, in accordance with nationally accepted coding guidelines.
Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.
In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be
reported using the billing codes and modifiers that most accurately represent the services rendered, unless
otherwise directed by the Company.