Cast Changes During the Global Period

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July 30, 2015

Question:
We have not been billing for cast changes during the global period, but have recently been told we should be reporting this service. In our orthopedic physician practice, on occasion a patient will require a cast change (for various reasons). If the physician orders the cast change and is present in the office during the cast change by our cast technician, can we bill Medicare during the 90-day global period?

Answer:
Thanks for your specific question and recognition that Incident-To rules apply in your scenario. Yes, if the physician orders the cast re-application and is in the office while the technician applies the cast, the service is billable to Medicare. Append modifier 58 to the cast application code since the patient is in a global period. Supplies are also reportable assuming the practice incurs the expense.