CurrentBlue KCPolicy POL-PP-244

Fracture Care — Casting, Splinting, Strapping and Related Supplies

Defines coding, billing, and reimbursement rules for application, removal, and replacement of casts, splints, and strapping in fracture/dislocation treatment for providers and facilities contracting with Blue KC.

Policy Summary

PayerBlue KC

PolicyFracture Care — Casting, Splinting, Strapping and Related Supplies

Policy CodePolicy POL-PP-244

Change TypeClarificationsannual review (no material changes)

Effective DateApr 1, 2024

Next Review DateApr 1, 2027

Key ActionED providers should report splint application and an E/M (99281-99285) with modifier 25 when stabilizing a fracture without performing restorative care.

SourceLink

POLICY UPDATE CHANGES

Clarification was added on original and replacement of casting, splinting, and strapping during and after the global period.

Annual review with no changes or updates made to the policy.

90 daysmajor procedure global period

Q4001-Q4051office supply HCPCS range

20100-29999musculoskeletal CPT range

Coverage Criteria for Fracture Care

Coverage criteria for fracture care

Policy Summary

PayerBlue KC

PolicyFracture Care — Casting, Splinting, Strapping and Related Supplies

Policy CodePolicy POL-PP-244

Change TypeClarificationsannual review (no material changes)

Effective DateApr 1, 2024

Next Review DateApr 1, 2027

Key ActionED providers should report splint application and an E/M (99281-99285) with modifier 25 when stabilizing a fracture without performing restorative care.

SourceLink

On This Page

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When a restorative procedure (CPT range 20100-29999) is performed by the same physician or entity, the initial application and removal of the first cast, splint, or strapping is included in the payment for the restorative procedure and is not separately reimbursable.

ED stabilization without restorative procedure: If a cast, splint, or strapping is applied by an ED physician without restorative treatment, the ED provider should report the splint application and an evaluation and management service (99281-99285) with modifier 25.

Global and split fracture care: The physician who performs the restorative procedure should bill globally (no modifier) and is responsible for subsequent fracture care during the global surgical package; an E/M on the day before or day of surgery may be billed with modifier 57 when appropriate.

Removal and replacement rules

Removal of the first cast, splint, or traction device is included in the restorative procedure and not separately reimbursable unless the initial application was performed by a different entity.
Subsequent replacement of cast, splint, or strapping during the global period (major procedures, 90 days) is not separately reimbursable.
Cast/splint replacement after the global period may be separately reimbursable when reasonable and necessary (examples include damaged cast, looseness, inadequate immobilization, skin irritation).

Supplies: No additional reimbursement for surgical trays or miscellaneous supply codes; if cast/splint/strapping is applied in the office, supplies may be billed separately with HCPCS Q4001-Q4051; supplies provided in a facility place of service are bundled into the facility reimbursement.

Codes and Coding Rules

Fracture care CPT rangesCPTCovered

21315-21499	Care of Fractures/Dislocations of the Cranial and Facial Bones.
26600-26785	Treatment of Fracture/Dislocation of Fingers and Hand.
28400-28675	Treatment of Fracture/Dislocation of Foot/Toe.
24500-24685	Treatment of Fracture/Dislocation of Elbow/Upper Arm.
21811-21825	Fracture Care: Ribs and Sternum.
27197-27269	Treatment of Fracture/Dislocation Hip/Pelvis.
22325-22328	Open Treatment Vertebral Fractures: Posterior Approach.
27750-27848	Treatment of Fracture/Dislocation Lower Leg/Ankle.
27500-27566	Treatment of Fracture/Dislocation of Femur/Knee.

Casting and splinting supplies (office-billable)HCPCSCovered

Q4001-Q4051

Casting and Splinting Supplies

Global period duration

Global period duration for major procedures90 days (major procedure global period) — cast/splint application and removal are included in the global package and not separately reimbursable during this period.

Applies to musculoskeletal restorative proceduresServices in the Musculoskeletal System section (CPT 20100-29999) include application/removal of the first cast/splint when performed by the same entity.

Responsibility for follow-up during global periodWhen restorative procedure is performed, the performing physician/entity is responsible for follow-up care included in the global payment.

Provider Billing and Modifier Guidance

Billing Rule

ED initial stabilization billing

When an ED provider stabilizes a fracture without performing restorative (definitive) treatment, report both the splint/cast application and an Evaluation & Management (E/M) service. Append modifier 25 to the E/M (CPT 99281-99285) when the E/M meets the separate and significant service criteria for the encounter.

Applicable E/M codes: 99281-99285
Use modifier 25 on the E/M when a significant, separately identifiable E/M is provided on the same day as splint/cast application
Report the appropriate splint/cast application code for the stabilization service

Billing Rule

Global/split care modifiers

The physician who performs the restorative (definitive) fracture procedure (typically the orthopedic surgeon) should bill the procedure code globally with no modifier. An E/M service provided by that physician on the day before or the day of surgery may be billed with modifier 57 when the E/M meets the key components indicating the decision for surgery. The physician who bills the global surgical package is responsible for all subsequent fracture care included in that global package; follow-up fracture care during the global period is not separately reimbursable. When a non-ED physician provides only follow-up care (postoperative care only), CPT modifier 55 (follow-up care only) may be appropriate.

Performing/restorative physician bills the procedure code globally (no modifier)
E/M on the day before or day of surgery: append modifier 57 when decision for surgery is documented and E/M key components are met
Follow-up fracture care during the global surgical package is not separately reimbursable
If a non-ED physician provides only follow-up care (no restorative procedure), CPT modifier 55 may be used

Definitions and Bundling Rules

Initial cast, splint, or strapping

DefinitionInitial application

ContextCasting, splinting, or strapping performed without an associated restorative musculoskeletal procedure (e.g., in ED) — may be billed separately per policy when restorative procedure is not performed by same entity.

Related CPT rangeMusculoskeletal system codes referenced: CPT 20100-29999 include services that incorporate initial application when performed with restorative procedure.

Removal of first cast when same entity performed restorative care

Inclusion in restorative procedureRemoval of the first cast, splint, or traction device is included in the restorative procedure when the initial application was performed by the same entity and is not separately reimbursable.

Exception — different entityIf the initial application was performed by a different entity, removal of the first cast may be billed separately.

Subsequent replacementsSubsequent replacement during the global period is not separately reimbursable; replacement after the global period may be reimbursable if reasonable and necessary.

Supply billing

Office supply billingCasting, splinting, and strapping supplies applied in the office may be billed separately using HCPCS codes Q4001–Q4051.

Facility suppliesSupplies provided in a facility place of service are bundled into the facility's reimbursement and are not separately reimbursable.

Surgical trays/misc suppliesNo additional reimbursement for surgical trays or other miscellaneous supply codes; these are considered bundled into other service payments.