Q4028 Pediatric Hip Spica | HCPCS Reimbursement

HCPCS Level II code Q4028 represents fiberglass cast supplies for a pediatric hip spica (one or both legs) for children aged 0–10 years. This item-level supply code is used to bill for the specific material and application type associated with immobilization of the hip and lower extremities in young patients. Nationally, accurate use of this code matters for tracking pediatric orthopedic supply utilization, ensuring correct claim adjudication, and aligning supply charges with payer coverage policies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for hip spica casting in pediatrics, the typical sites where the supply is used, and the payer landscape relevant to reimbursement and coverage determinations. The publication provides benchmarks where available, notes on billing practice considerations, and outlines items commonly addressed in payer policies for pediatric casting supplies. Data not available in the input where details were not provided.

Billing Code Overview

HCPCS Level II code Q4028 describes cast supplies for a hip spica (one or both legs) for pediatric patients aged 0–10 years, specifying fiberglass as the material. The service type is orthopedic casting supply intended for immobilization of the hip and lower extremities in young children. Typical site of service includes hospital outpatient departments, ambulatory surgery centers, orthopedic clinics, and emergency departments where pediatric casting is performed. Data not available in the input.

Clinical Context

A toddler aged 18 months presents to the orthopedic clinic after a low-energy spiral femoral shaft fracture following a fall from a low height. The orthopedist determines that a hip spica cast is the appropriate immobilization to stabilize the fracture and maintain hip and knee alignment. In the clinical workflow, the child is brought to the casting suite or outpatient procedure room; nursing obtains consent, pain control is provided (oral or intranasal analgesia; conscious sedation only if required), and the child is positioned on a pediatric casting table. A stockinette and padding are applied, then a circumferential fiberglass hip spica cast is molded to include the pelvis and one or both lower extremities as indicated. Caregiver education on cast care, skin checks, and follow-up imaging is provided. A cast supply charge for pediatric fiberglass hip spica materials is billed using Q4028 when applicable, typically in ambulatory surgical centers, hospital outpatient departments, pediatric orthopedic clinics, or emergency department procedure areas. Typical payors for authorization and payment adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the hip spica includes the left lower extremity specifically and payer requires laterality

Taxonomy Code	Specialty	Notes
`2080P0207X`	Orthopaedic Surgery	Pediatric and general orthopedists commonly apply hip spica casts
`207L00000X`	Pediatric Medicine	Pediatricians may be involved in fracture care coordination and sedation management
`330400000X`	Emergency Medicine	Emergency physicians or proceduralists may apply hip spica casts in urgent settings
`3336C0003X`	Orthopedic Cast Technician	Cast technicians and orthotists supply and prepare materials under provider direction
`261QM0800X`	Physical Medicine & Rehabilitation	Rehabilitation specialists may manage follow-up care and mobility planning

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.301A`	Unspecified fracture of shaft of right femur, initial encounter for closed fracture	Mid-shaft femoral fractures in toddlers commonly require hip spica immobilization
`S72.302A`	Unspecified fracture of shaft of left femur, initial encounter for closed fracture	Left-sided femoral shaft fractures managed with hip spica cast
`S72.303A`	Unspecified fracture of shaft of femur, initial encounter for closed fracture, bilateral	Bilateral femoral injuries that necessitate bilateral hip spica application
`S72.001A`	Fracture of unspecified part of neck of right femur, initial encounter for closed fracture	Proximal femoral fractures in young children sometimes immobilized in spica cast
`S72.002A`	Fracture of unspecified part of neck of left femur, initial encounter for closed fracture	Left proximal femur injuries managed with spica cast when indicated

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29305`	Application of hip spica cast (one or both legs)	Directly corresponds to application of a hip spica cast; often performed alongside billing for cast supplies `Q4028` when applicable
`29325`	Application of long leg cast, hip to toe	Alternative immobilization; may be used when hip spica is not indicated or for different fracture patterns
`29075`	Application of short leg cast (knee to toe)	Used for distal lower extremity immobilization when hip spica is not required; relevant for comparison of supply needs
`99070`	Supplies and materials (except spectacles), used by the physician or supplier, not included in the service	May be used by some payors to report additional non-stock cast supplies not covered by `Q4028`
`99152`	Moderate sedation services provided by the physician or other qualified health care professional (initial 15 minutes)	When conscious sedation is provided for cast application in pediatric patients and must be reported per payer rules

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Summary & Overview

HCPCS Level II Q4028: Pediatric Hip Spica Fiberglass Cast Supplies