Wiki PROBLEMS WITH Q CODES FOR CASTING SUPPLIES

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dhuttie

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Is anyone having a problem getting paid for casting supplies, the Q codes. We seem to be having problems with Anthem. Interested to see if anyone else is having problems. We are in Ohio.
 
We were having this issue with Health Partners and BCBS of MN for a while. We had to send appeals and used these resources to explain to them that the Q Codes were created in 2001and the payment for the application was reduced. We used the Medicare Program memorandum dated 04/24/2001 Transmittal AB-01-60, the Coders Pink sheet dated July 2008 which shows the crosswalk cast application codes to the supply Q codes and the MLN Matters article number MM8645 released on 03/11/2014 which shows the Quarterly update for Casting supplies and then also told them where to find the current allowable Medicare fees for these Q Codes. The Q Codes are a separately billable supply and even CPT states this at the beginning of the cast and splint application codes. Good luck!
 
The only Q code we seem to have an issue with is Q4050, with BCBS especially they require that you add "waterproof cast lining" or something along those lines in the Non-Specific Procedure (NOC) Codes Description.
 
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