Reimbursement

Physician Office and Hospital Outpatient Setting - Coding

PRODUCT CODING - Physician Office ONLY
HCPCS           Code Descriptor
Q4038           Cast Supplies, short leg cast, adult [11 years +], fiberglass

APPLICATION CODING - Physician Office and Hospital Outpatient Department
CPT          Code Descriptor
29445          Application of rigid total contact leg cast

Hospital Outpatient Setting - Reimbursement

MEDICARE FACILITY REIMBURSEMENT* - Hospital Outpatient
CPT 29445             $158.11 - Links to APC code 0426
Q4038         Not separately payable by Medicare, but may be paid by other insurances

MEDICARE PHYSICIAN REIMBURSEMENT* - Hospital Outpatient
CPT 29445             $ 106.76
Q4038          Not separately payable; the physician did not incur the cost for the supply

Physician Office Setting- Reimbursement

MEDICARE PHYSICIAN REIMBURSEMENT - Physician Office
CPT 29445             $ 132.88

Q4038 $ 30 - $50 per roll of fiberglass applied
ICD-9-CM DIAGNOSIS CODING:
Diagnoses codes are determined by the provider, as applicable.

*Amount represents Medicare's national average fee schedule for these services. Medicare payment is based on 80

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