2019 Splinting & Casting Reimbursement Update
When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (commonly referred to as “Q codes”) is not subject to the Geographic Practice Cost Index (GPCI) adjustment and is only adjusted quarterly with the DWC adoption of the Medicare rates.
With flat reimbursement rates statewide, Q codes are calculated at a straight 120% of Medicare’s allotment from CMS’ Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) table. Back in 2014, the splinting and casting codes were folded into the DMEPOS reimbursement and are covered by HCPCS codes commencing with Q4001 through Q4049.
On average, the 2019 rates for the Q codes went up by 2.25% from the 2018 rates. Given the straightforward computation, the following table illustrates expected 2019 reimbursements for the casting & splinting Q codes coupled with the 2018 reimbursements.
HCPCS |
Description |
2018 Reimbursement |
2019 Reimbursement |
Percent Change |
Q4001 |
Cast supplies, body cast, plaster |
$59.11 |
$60.47 |
2.24% |
Q4002 |
Cast supplies, body cast, fiberglass
|
$223.32 |
$228.46 |
2.25% |
Q4003 |
Cast supplies, shoulder cast, plaster |
$42.43 |
$43.40 |
2.24% |
Q4004 |
Cast supplies, shoulder cast, fiberglass |
$146.92 |
$150.30 |
2.25% |
Q4005 |
Cast supplies, long arm, adult, plaster |
$15.65 |
$16.01 |
2.25% |
Q4006 |
Cast supplies, long arm, adult, fiberglass |
$35.26 |
$36.07 |
2.26% |
Q4007 |
Cast supplies, long arm, pediatric, plaster |
$7.82 |
$8.00 |
2.25% |
Q4008 |
Cast supplies, long arm, pediatric, fiberglass |
$17.62 |
$18.02 |
2.26% |
Q4009 |
Cast supplies, short arm, adult, plaster |
$10.45 |
$10.69 |
2.24% |
Q4010 |
Cast supplies, short arm, adult, fiberglass |
$23.51 |
$24.05 |
2.25% |
Q4011 |
Cast supplies, short arm, pediatric, plaster |
$5.21 |
$5.33 |
2.25% |
Q4012 |
Cast supplies, short arm, pediatric, fiberglass |
$11.77 |
$12.05 |
2.29% |
Q4013 |
Cast supplies, gauntlet, plaster |
$19.02 |
$19.45 |
2.22% |
Q4014 |
Cast supplies, gauntlet, fiberglass |
$32.06 |
$32.80 |
2.23% |
Q4015 |
Cast supplies, gauntlet, pediatric, plaster |
$9.53 |
$9.74 |
2.22% |
Q4016 |
Cast supplies, gauntlet, pediatric, fiberglass |
$16.03 |
$16.40 |
2.27% |
Q4017 |
Cast supplies, long arm splint, plaster |
$10.99 |
$11.24 |
2.24% |
Q4018 |
Cast supplies, long arm splint, fiberglass |
$17.52 |
$17.93 |
2.28% |
Q4019 |
Cast supplies, long arm splint, pediatric, plaster |
$5.51 |
$5.64 |
2.34% |
Q4020 |
Cast supplies, long arm splint, pediatric, fiberglass |
$8.78 |
$8.99 |
2.27% |
Q4021 |
Cast supplies, short arm splint, plaster |
$8.14 |
$8.33 |
2.31% |
Q4022 |
Cast supplies, short arm, splint, fiberglass |
$14.68 |
$15.01 |
2.24% |
Q4023 |
Cast supplies, short arm splint, pediatric, plaster |
$4.09 |
$4.19 |
2.29% |
Q4024 |
Cast support, short arm splint, pediatric, fiberglass |
$7.36 |
$7.52 |
2.23% |
Q4025 |
Cast supplies, hip spica, plaster |
$45.61 |
$46.66 |
2.24% |
Q4026 |
Cast supplies, hip spica, fiberglass |
$142.45 |
$145.73 |
2.25% |
Q4027 |
Cast supplies, hip spica, pediatric, plaster |
$22.82 |
$23.35 |
2.26% |
Q4028 |
Cast supplies, hip spica, pediatric, fiberglass |
$71.27 |
$72.91 |
2.25% |
Q4029 |
Cast supplies, long leg, plaster |
$34.90 |
$35.70 |
2.25% |
Q4030 |
Cast supplies, long leg, fiberglass |
$91.85 |
$93.96 |
2.25% |
Q4031 |
Cast supplies, long leg, pediatric, plaster |
$17.44 |
$17.83 |
2.22% |
Q4032 |
Cast supplies, long leg, pediatric, fiberglass |
$45.92 |
$46.98 |
2.25% |
Q4033 |
Cast supplies, long leg cylinder, plaster |
$32.56 |
$33.30 |
2.23% |
Q4034 |
Cast supplies, long leg cylinder, fiberglass |
$80.93 |
$82.79 |
2.25% |
Q4035 |
Cast supplies, long leg cylinder, pediatric, plaster |
$16.27 |
$16.64 |
2.24% |
Q4036 |
Cast supplies, long leg cylinder, pediatric, fiberglass |
$40.49 |
$41.42 |
2.26% |
Q4037 |
Cast supplies, short leg, plaster |
$19.84 |
$20.29 |
2.25% |
Q4038 |
Cast supplies, short leg, fiberglass |
$49.73 |
$50.87 |
2.24% |
Q4039 |
Cast supplies, short leg, pediatric, plaster |
$9.95 |
$10.18 |
2.24% |
Q4040 |
Cast supplies, short leg, pediatric, fiberglass |
$24.86 |
$25.44 |
2.26% |
Q4041 |
Cast supplies, long leg splint, plaster |
$24.14 |
$24.70 |
2.24% |
Q4042 |
Cast supplies, long leg splint, fiberglass |
$41.21 |
$42.16 |
2.25% |
Q4043 |
Cast supplies, long leg splint, pediatric, plaster |
$12.08 |
$12.36 |
2.23% |
Q4044 |
Cast supplies, long leg splint, pediatric, fiberglass |
$20.62 |
$21.10 |
2.28% |
Q4045 |
Cast supplies, short leg splint, plaster |
$14.02 |
$14.34 |
2.26% |
Q4046 |
Cast supplies, short leg splint, fiberglass |
$22.54 |
$23.05 |
2.24% |
Q4047 |
Cast supplies, short leg splint, pediatric, plaster |
$6.98 |
$7.14 |
2.18% |
Q4048 |
Cast supplies, short leg splint, pediatric, fiberglass |
$11.27 |
$11.53 |
2.29% |
Q4049 |
Finger splint, static |
$2.54 |
$2.60 |
2.30% |
These updates and more are included in DaisyBill’s powerful and comprehensive OMFS Calculator, which is included in the Work Comp Wizard tool. Sign up now for a three-day demo and see the most up-to-date reimbursement computations in action and cross-reference old reimbursements for older dates of service.
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