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Policy Attachment

MA00.012c
A
MA00.012c
Procedures Related to Cast and Splint Applications and Associated Supplies
Cast and Splint Applications and Associated Supplies


Cast Application:
Codes
29010
29015
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:
Codes​
29105
29125
29126
29130
29131
29505
29515

Removal and Repair:
Codes
29700
29705
29710
29720
29730
29740
29750
29799​​

HCPCS Level II

Cast and Splint Supplies:
Codes
Narrative Description
Q4001Casting supplies, body cast adult, with or without head, plaster
Q4002Cast supplies, body cast adult, with or without head, fiberglass
Q4003Cast supplies, shoulder cast, adult (11 years +), plaster
Q4004Cast supplies, shoulder cast, adult (11 years +), fiberglass
Q4005Cast supplies, long arm cast, adult (11 years +), plaster
Q4006Cast supplies, long arm cast, adult (11 years +), fiberglass
Q4007Cast supplies, long arm cast, pediatric (0-10 years), plaster
Q4008Cast supplies, long arm cast, pediatric (0-10 years), fiberglass
Q4009Cast supplies, short arm cast, adult (11 years +), plaster
Q4010Cast supplies, short arm cast, adult (11 years +), fiberglass
Q4011Cast supplies, short arm cast, pediatric (0-10 years), plaster
Q4012Cast supplies, short arm cast, pediatric (0-10 years), fiberglass
Q4013Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster
Q4014Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass
Q4015Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster
Q4016Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass
Q4017Cast supplies, long arm splint, adult (11 years +), plaster
Q4018Cast supplies, long arm splint, adult (11 years +), fiberglass
Q4019Cast supplies, long arm splint, pediatric (0-10 years), plaster
Q4020Cast supplies, long arm splint, pediatric (0-10 years), fiberglass
Q4021Cast supplies, short arm splint, adult (11 years +), plaster
Q4022Cast supplies, short arm splint, adult (11 years +), fiberglass
Q4023Cast supplies, short arm splint, pediatric (0-10 years), plaster
Q4024Cast supplies, short arm splint, pediatric (0-10 years), fiberglass
Q4025Cast supplies, hip spica (one or both legs), adult (11 years +), plaster
Q4026Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass
Q4027Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster
Q4028Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass
Q4029Cast supplies, long leg cast, adult (11 years +), plaster
Q4030Cast supplies, long leg cast, adult (11 years +), fiberglass
Q4031Cast supplies, long leg cast, pediatric (0-10 years), plaster
Q4032Cast supplies, long leg cast, pediatric (0-10 years), fiberglass
Q4033Cast supplies, long leg cylinder cast, adult (11 years +), plaster
Q4034Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass
Q4035Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster
Q4036Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass
Q4037Cast supplies, short leg cast, adult (11 years +), plaster
Q4038Cast supplies, short leg cast, adult (11 years +), fiberglass
Q4039Cast supplies, short leg cast, pediatric (0-10 years), plaster
Q4040Cast supplies, short leg cast, pediatric (0-10 years), fiberglass
Q4041Cast supplies, long leg splint, adult (11 years +), plaster
Q4042Cast supplies, long leg splint, adult (11 years +), fiberglass
Q4043Cast supplies, long leg splint, pediatric (0-10 years), plaster
Q4044Cast supplies, long leg splint, pediatric (0-10 years), fiberglass
Q4045Cast supplies, short leg splint, adult (11 years +), plaster
Q4046Cast supplies, short leg splint, adult (11 years +), fiberglass
Q4047Cast supplies, short leg splint, pediatric (0-10 years), plaster
Q4048Cast supplies, short leg splint, pediatric (0-10 years), fiberglass
Q4049Finger splint, static
Q4050Cast supplies, for unlisted types and materials of casts
Q4051Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)
S8450Splint, prefabricated, digit (Specify digit by use of modifier)
S8451Splint, prefabricated, wrist or ankle
S8452Splint, prefabricated, elbow

Miscellaneous Supplies:
Codes
Narrative Description
A4565Slings

The following HCPCS codes are not eligible for reimbursement consideration.
Codes
Narrative Description
A4570Splint
A4580Cast supplies (e.g., plaster)
A4590Special casting material (e.g., fiberglass)


01/01/2024
01/01/2024
09/18/2024
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