Follow 2013 Instructions for Splints, Casts, and Intraocular Lenses Payment

Medicare payment continues in 2013 for splints, casts, and intraocular lenses implanted in a physician’s office. Effective Jan. 1, 2013, the Centers for Medicare & Medicaid Services (CMS) instructs:

  • For splints and casts, HCPCS Level II Q codes should be used when supplies are indicated for cast and splint purposes. This payment is in addition to the physician fee schedule procedure payment for applying the splint or cast.
  • For intraocular lenses, payment is only made on a reasonable charge basis for lenses implanted in a physician’s office (HCPCS Level II codes V2630 Anterior chamber intraocular lens, V2631 Iris supported intraocular lens, and V2632 Posterior chamber intraocular lens).

The 2013 payment limits for splints and casts are based on the 2012 limits announced in last year’s Change Request (CR) 7628, increased by 1.7 percent. 2013 payment limits for splints and casts are:

2013 Payment Limits for Splints and Casts
A4565 $8.26 Q4013 $15.13 Q4026 $113.30 Q4039 $7.91
Q4001 $47.00 Q4014 $25.51 Q4027 $18.15 Q4040 $19.77
Q4002 $177.62 Q4015 $7.57 Q4028 $56.67 Q4041 $19.20
Q4003 $33.75 Q4016 $12.75 Q4029 $27.75 Q4042 $32.78
Q4004 $116.86 Q4017 $8.75 Q4030 $73.05 Q4043 $9.61
Q4005 $12.45 Q4018 $13.94 Q4031 $13.87 Q4044 $16.39
Q4006 $28.05 Q4019 $4.38 Q4032 $36.52 Q4045 $11.15
Q4007 $6.23 Q4020 $6.98 Q4033 $25.88 Q4046 $17.93
Q4008 $14.02 Q4021 $6.47 Q4034 $64.38 Q4047 $5.56
Q4009 $8.31 Q4022 $11.68 Q4035 $12.94 Q4048 $8.97
Q4010 $18.70 Q4023 $3.25 Q4036 $32.20 Q4049 $2.03
Q4011 $4.15 Q4024 $5.84 Q4037 $15.79
Q4012 $9.36 Q4025 $36.29 Q4038 $39.56

Splints and casts furnished in 2013 will be paid based on the lower of the actual charge or the aforementioned payment limits.

See MLN Matters MM8051 and CR 8051 for more information.

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