Reimbursement for Total Contact Casting

*CMS moved TCC [CPT 29445] from APC 0426 in 2014 to APC 0058 for Level II Strapping & Cast Procedure w/a 60% increased in the national unadjusted 2015 fee of $223.30.

Debridement – Medicare does pay for Total Contact Casting when applied after debridement codes 97597 and 97598 are used. This should take away most of the objection about billing debridement and Total Contact Casting. CMS still does not pay for debridement and TCC when the 11042 or 11043 codes are used.

Physician Office and Hospital Outpatient Setting – Coding
Code Code Descriptor
PRODUCT CODING – Physician Office ONLY
Q4038 (cast supplies, short leg cast, adult [11 years +], fiberglass)
APPLICATION CODING – Physician Office and Hospital Outpatient Department
29445 Application of rigid total contact leg cast

Hospital Outpatient Setting – Reimbursement
Code Code Descriptor

MEDICARE FACILITY REIMBURSEMENT** – Hospital Outpatient
CPT 29445 $175.39 – 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 $107.71
Q4038 Not separately payable; the physician did not incur the cost for the supply

Physician Office Setting- Reimbursement
Code Code Descriptor

MEDICARE PHYSICIAN REIMBURSEMENT – Physician Office
CPT 29445 $137.26
Q4038 $30 – $50 per application

*http://aawconline.org/wp-content/uploads/2015/11/ALERT_2015-HOPPS-Changes.pdf
**Amount represents Medicare's national average fee schedule for these services. Medicare payment is based on 80 percent of the fee schedule amount. The patient (or secondary insurer) is responsible for the remaining 20 percent. Each insurer's specific coverage policies apply, if available.

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