Summary & Overview
HCPCS Q4013: Gauntlet Plaster Cast for Lower Forearm and Hand, Adult
HCPCS Level II code Q4013 represents plaster gauntlet cast supplies for adults (11 years and older) covering the lower forearm and hand. This supply code matters nationally because casting is a common intervention for fractures, ligament injuries, and post-operative immobilization; classification as an HCPCS Level II code guides supply billing, reimbursement, and administrative processing across payers. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code covers, the typical settings where the supply is provided, and the clinical context for use. The publication outlines billing and coverage considerations across major payers, including common modifiers and coding relationships where available, and flags areas where payers may have differing policies on supply reimbursement. The analysis also summarizes typical clinical indications for a gauntlet cast and contrasts supply-based billing with procedure-level cast application codes. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific reimbursement benchmarks.
Billing Code Overview
HCPCS Level II code Q4013 describes cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster. The service represented is application or provision of a plaster gauntlet cast for adults, intended to immobilize the lower forearm and hand. The typical site of service for this supply is ambulatory surgical centers, hospital outpatient departments, orthopedic clinics, emergency departments, and other outpatient settings where casting is performed.
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Clinical & Coding Specifications
Clinical Context
A typical adult patient (age 11 years and older) presents to an orthopedic clinic or urgent care after a fall onto an outstretched hand with pain, swelling, and limited wrist/hand motion. The clinician evaluates the patient, obtains wrist and forearm radiographs to assess for distal radius, scaphoid, or metacarpal fractures or significant soft tissue injury. When a non-operative fracture or acute wrist/hand soft-tissue injury requires immobilization, a plaster gauntlet cast (covering the lower forearm and hand) is applied to immobilize the lower forearm and hand to reduce pain and permit healing. The clinical workflow includes patient evaluation, imaging, decision for immobilization, obtaining informed consent, application of Q4013 cast supplies for an adult plaster gauntlet cast, brief instruction on cast care, and scheduling follow-up for cast check and repeat imaging as indicated. Typical sites of service include outpatient orthopedic clinics, urgent care centers, emergency departments, and ambulatory surgical centers when performed as part of non-operative fracture care or temporary immobilization prior to definitive treatment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the gauntlet cast is applied to the left hand/lower forearm |