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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.

OMFS CALCULATOR
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