Q4004 HCPCS code: Cast supplies, shoulder cast, adult (11 years +), fiberglass
Q4004 is the HCPCS Level II code for cast supplies, shoulder cast, adult (11 years +), fiberglass. The 2026 Medicare DMEPOS fee schedule pays $155.03 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume fell 20% from 2022 to 2023 (15 to 12 services). In 2023, about 10 clinicians billed Medicare for Q4004 for 12 beneficiaries. Its average fee ranks 48 of 49 Q40 codes (family range $2.68–$235.64).
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 55 |
| BETOS category | D1A — Medical/surgical supplies |
| Added | 2001-07-01 |
| Last action effective | 2014-10-01 |
2026 Medicare DMEPOS fee schedule for Q4004
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $155.03 | $155.03 | $155.03 | $131.78 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $155.03 | — |
| AL | — | $155.03 | — |
| AR | — | $155.03 | — |
| AZ | — | $155.03 | — |
| CA | — | $155.03 | — |
| CO | — | $155.03 | — |
| CT | — | $155.03 | — |
| DC | — | $155.03 | — |
| DE | — | $155.03 | — |
| FL | — | $155.03 | — |
| GA | — | $155.03 | — |
| HI | — | $155.03 | — |
| IA | — | $155.03 | — |
| ID | — | $155.03 | — |
| IL | — | $155.03 | — |
| IN | — | $155.03 | — |
| KS | — | $155.03 | — |
| KY | — | $155.03 | — |
| LA | — | $155.03 | — |
| MA | — | $155.03 | — |
| MD | — | $155.03 | — |
| ME | — | $155.03 | — |
| MI | — | $155.03 | — |
| MN | — | $155.03 | — |
| MO | — | $155.03 | — |
| MS | — | $155.03 | — |
| MT | — | $155.03 | — |
| NC | — | $155.03 | — |
| ND | — | $155.03 | — |
| NE | — | $155.03 | — |
| NH | — | $155.03 | — |
| NJ | — | $155.03 | — |
| NM | — | $155.03 | — |
| NV | — | $155.03 | — |
| NY | — | $155.03 | — |
| OH | — | $155.03 | — |
| OK | — | $155.03 | — |
| OR | — | $155.03 | — |
| PA | — | $155.03 | — |
| PR | — | $155.03 | — |
| RI | — | $155.03 | — |
| SC | — | $155.03 | — |
| SD | — | $155.03 | — |
| TN | — | $155.03 | — |
| TX | — | $155.03 | — |
| UT | — | $155.03 | — |
| VA | — | $155.03 | — |
| VI | — | $155.03 | — |
| VT | — | $155.03 | — |
| WA | — | $155.03 | — |
| WI | — | $155.03 | — |
| WV | — | $155.03 | — |
| WY | — | $155.03 | — |
How the Q4004 fee compares
| Measure | Value |
|---|---|
| Rank among 49 Q40 codes (lowest = 1) | 48 |
| Family fee range (average of state fees) | $2.68–$235.64 |
| Rural fee uplift | — |
Who bills Q4004 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 10 |
| Medicare beneficiaries | 12 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4004, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 15 | 15 | $116.43 | $92.94 |
| 2023 | 12 | 12 | $100.51 | $80.08 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Anatomic Consideration |
| practitioner claims | 2 | Anatomic Consideration |
What changed for Q4004
- 2026-01-01: Average state fee rose 2.0%: $151.99 to $155.03
- 2001-07-01: Q4004 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q4004?
Q4004 is the HCPCS Level II code for cast supplies, shoulder cast, adult (11 years +), fiberglass. Short descriptor: "Cast sup shoulder cast fbrgl".
How much does Medicare pay for Q4004?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $155.03. Rural fees can be higher.
Does Medicare cover Q4004?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for Q4004 change in 2026?
The average non-rural state fee moved from $151.99 in 2025 to $155.03 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of Q4004 can be billed per day?
2 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related Q40 codes
- Q4001 — Casting supplies, body cast adult, with or without head, plaster ($62.36–$62.36)
- Q4002 — Cast supplies, body cast adult, with or without head, fiberglass ($235.64–$235.64)
- Q4003 — Cast supplies, shoulder cast, adult (11 years +), plaster ($44.78–$44.78)
- Q4005 — Cast supplies, long arm cast, adult (11 years +), plaster ($16.51–$16.51)
- Q4006 — Cast supplies, long arm cast, adult (11 years +), fiberglass ($37.20–$37.20)
- Q4007 — Cast supplies, long arm cast, pediatric (0-10 years), plaster ($8.25–$8.25)
- Q4008 — Cast supplies, long arm cast, pediatric (0-10 years), fiberglass ($18.59–$18.59)
- Q4009 — Cast supplies, short arm cast, adult (11 years +), plaster ($11.03–$11.03)
- Q4010 — Cast supplies, short arm cast, adult (11 years +), fiberglass ($24.80–$24.80)
- Q4011 — Cast supplies, short arm cast, pediatric (0-10 years), plaster ($5.50–$5.50)
- Q4012 — Cast supplies, short arm cast, pediatric (0-10 years), fiberglass ($12.43–$12.43)
- Q4013 — Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster ($20.07–$20.07)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q4004
- Watch Q4004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4004
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.