HCPCS Q4038 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Temporary Codes • Cast and Splint Supplies |
| Complexity Level | Low |
National average reimbursement for HCPCS Q4038 by major payers:
$43.51
$27.55
$46.43
$41.29
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS Q4038 | ||||||
United | Q4038 | $24.13 | 1164764445 - MATTHEW DAVIS | 591286000 - (FL) TALLAHASSEE NEUROLOGICAL CLINIC, P. | FL | Neurological Surgery Physician (207T00000X) |
United | Q4038 | $21.80 | 1659363679 - EDWARD FAZEKAS | 591271306 - (FL) ODRO, FAZEKAS, & WERD, P.A. | FL | Podiatrist (213E00000X) |
United | Q4038 | $24.43 | 1922482322 - PATRICK KIM | 237313346 - (FL) UNIVERSITY MEDICAL SERVICE ASSOCIATION INC | FL | Neurological Surgery Physician (207T00000X) |
United | Q4038 | $25.43 | 1922050400 - JEFFREY ANGLEN | 356004464 - (IN) RUSH MEMORIAL HOSPITAL | FL | Orthopaedic Trauma Physician (207XX0801X) |
United | Q4038 | $24.59 | 1669677514 - DEVON HAYDON | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | Q4038 | $17.11 | 1548270788 - MICHAEL GOODMAN | 272481555 | FL | Neurological Surgery Physician (207T00000X) |
United | Q4038 | $24.15 | 1992723647 - TIMOTHY SYPEREK | 650429853 | FL | Podiatrist (213E00000X) |
United | Q4038 | $72.98 | 1356874929 - GAN GOLSHTEYN | 270271872 | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | Q4038 | $26.45 | 1730541806 - PAUL MCBRIDE | 462021581 - (FL) FLORIDA HOSPITAL PHYSICIAN GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | Q4038 | $25.65 | 1356092621 - MARILYN TORIBIO | 822410133 | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | Q4038 | $24.15 | 1124015128 - JAMES LOSITO | 650429853 | FL | Sports Medicine Podiatrist (213ES0000X) |
United | Q4038 | $25.65 | 1699063511 - JAY SEIDEL | 465483971 - JAY SEIDEL DPM PA INC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | Q4038 | $21.21 | 1891127304 - MEGAN ZIEMER | 582047184 - (FL) TIMOTHY C RUNYON DPM PA | FL | Podiatrist (213E00000X) |
United | Q4038 | $25.65 | 1245485259 - D.S. MILES DPM, PA, DAWN S. MILES DPM PA | 593675191 - (FL) D S MILES D P M P A | FL | Podiatrist (213E00000X) |
United | Q4038 | $25.65 | 1063775039 - HOWARD BAR-ELI | 260886056 - (FL) BAPTIST HEALTH MEDICAL GROUP ORTHOPEDICS LLC | NJ | Orthopaedic Trauma Physician (207XX0801X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS Q4038 vs. Other Cast and Splint Supplies Codes
The HCPCS Q4038 code is part of the Temporary Codes services used for Cast and Splint Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS Q4038 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| Q4037-HCPCS | Low | Cast supplies, short leg cast, adult (11 years +), plaster |
| Q4038-HCPCS | Low | Cast supplies, short leg cast, adult (11 years +), fiberglass |
| Q4039-HCPCS | Low | Cast supplies, short leg cast, pediatric (0-10 years), plaster |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q4038. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q4038 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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