Orthopedic Coding Alert

Question: How should I handle billing and reimbursement for Gore-Tex cast padding? More and more patients are requesting it, and our supplier just raised prices significantly.
                                                      Colorado Subscriber  
     
Answer: Reimbursement for supply items is variable and subject to carrier discretion. Active patients request Gore-Tex more frequently now because it is water-repellent and they can participate in more activities. Remember that you are supplying this material as a convenience to the patient as opposed to a necessity. Insurance carriers frequently do not reimburse for cast materials and rarely reimburse for a luxury item like Gore-Tex when less costly materials will do just as well.
 
Patients who request Gore-Tex casting materials should be advised that they will have to bear the cost differential for this item and sign a financial liability statement attesting to the fact that they have opted to receive the materials. It is important to collect the patients payment at the time of service.
 
As for carriers, the best plan is to ask them how they want you to bill for this. The new HCPCS codes for Gore-Tex are Q4050 or Q4051 (unlisted and miscellaneous cast and splint supplies). When submitting a claim for Gore-Tex, you should include a letter to the carrier explaining why this particular supply was being used, etc., and attach a copy of your invoice.