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Coding and reimbursement may vary by payer. Per Medicare guidelines, physician offices (practices that bill on the CMS 1500 claim form) may bill for the cast supplies and the appropriate CPT code for the application of the cast.
Please follow specific guidelines for the MAC, commercial payer, state Medicaid or other payer.
+ Since the HM Cast is not a fiberglass or plaster cast, the miscellaneous code is the most appropriate code, as codes Q4001 - Q4048 describe fiberglass or plaster cast materials.
+ When using the miscellaneous cast code Q4050, it is important to also provide a description on the claim and other documentation to support medical necessity, including a description of which extremity is being treated.
+ It is typical to use the invoice for the product for pricing for the miscellaneous cast supply code.
Product Description
The HM Cast (Hybrid Mesh Cast) is the first orthopedic tubular immobilization system, which is designed from special materials and offers a One-Step Solution, All-In-One-Kit. The product includes a hydro and oleo phobic padding sleeve and a special hybrid mesh with a proprietary hardening resin that overlays the padding. The hybrid mesh tube is mixed with water and laid over the padding on the treated area. It hardens within minutes to immobilize the affected limb fracture. The procedure is cleaner and faster than traditional or fiberglass casts. It is lightweight, breatheable and does not interfere with radiology. It is also not affected by water, allowing patients to freely take showers or baths. A licensed healthcare professional will set the fracture.
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