Cast and splint application, reapplication, removal, and repair for non-surgical treatments of injuries (e.g. sprains, dislocations) may be covered and eligible for reimbursement consideration by the Company.
Cast and splint applications are not eligible for separate reimbursement consideration when billed within the postoperative period of a procedure to repair an open or closed fracture. Payment is included in the global allowance of the procedure to repair an open or closed fracture.
Additionally, the reapplication, removal, and repair of a cast or splint, when performed by the same professional provider or provider group, is not eligible for separate reimbursement consideration by the Company. Payment is included in the global allowance of the procedure to repair an open or closed fracture.
The reapplication, removal, and repair of a cast or splint may be eligible for separate reimbursement consideration by the Company, when performed by a different professional provider or provider group other than the provider who initially performed the procedure to repair the open or closed fracture.
Associated supplies, listed in Attachment A of this policy, used in the application, reapplication, removal, and repair of a cast or splint may be eligible for separate reimbursement.
The following HCPCS codes represent general codes and are not eligible for reimbursement consideration.
- Splints – A4570
- Cast supplies (e.g., plaster) – A4580
- Special casting material (e.g., fiberglass) – A4590
The initial application of a localizer jacket following scoliosis surgery may be eligible for separate reimbursement.
Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
REQUIRED DOCUMENTATION
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
