Q4042 HCPCS code: Cast supplies, long leg splint, adult (11 years +), fiberglass
Q4042 is the HCPCS Level II code for cast supplies, long leg splint, adult (11 years +), fiberglass. The 2026 Medicare DMEPOS fee schedule pays $43.49 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 21% from 2022 to 2024 (530 to 418 services). In 2024, about 338 clinicians billed Medicare for Q4042 for 378 beneficiaries; California, Florida, Oklahoma accounted for 40% of services. Its average fee ranks 38 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 Q4042
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $43.49 | $43.49 | $43.49 | $36.97 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $43.49 | — |
| AL | — | $43.49 | — |
| AR | — | $43.49 | — |
| AZ | — | $43.49 | — |
| CA | — | $43.49 | — |
| CO | — | $43.49 | — |
| CT | — | $43.49 | — |
| DC | — | $43.49 | — |
| DE | — | $43.49 | — |
| FL | — | $43.49 | — |
| GA | — | $43.49 | — |
| HI | — | $43.49 | — |
| IA | — | $43.49 | — |
| ID | — | $43.49 | — |
| IL | — | $43.49 | — |
| IN | — | $43.49 | — |
| KS | — | $43.49 | — |
| KY | — | $43.49 | — |
| LA | — | $43.49 | — |
| MA | — | $43.49 | — |
| MD | — | $43.49 | — |
| ME | — | $43.49 | — |
| MI | — | $43.49 | — |
| MN | — | $43.49 | — |
| MO | — | $43.49 | — |
| MS | — | $43.49 | — |
| MT | — | $43.49 | — |
| NC | — | $43.49 | — |
| ND | — | $43.49 | — |
| NE | — | $43.49 | — |
| NH | — | $43.49 | — |
| NJ | — | $43.49 | — |
| NM | — | $43.49 | — |
| NV | — | $43.49 | — |
| NY | — | $43.49 | — |
| OH | — | $43.49 | — |
| OK | — | $43.49 | — |
| OR | — | $43.49 | — |
| PA | — | $43.49 | — |
| PR | — | $43.49 | — |
| RI | — | $43.49 | — |
| SC | — | $43.49 | — |
| SD | — | $43.49 | — |
| TN | — | $43.49 | — |
| TX | — | $43.49 | — |
| UT | — | $43.49 | — |
| VA | — | $43.49 | — |
| VI | — | $43.49 | — |
| VT | — | $43.49 | — |
| WA | — | $43.49 | — |
| WI | — | $43.49 | — |
| WV | — | $43.49 | — |
| WY | — | $43.49 | — |
How the Q4042 fee compares
| Measure | Value |
|---|---|
| Rank among 49 Q40 codes (lowest = 1) | 38 |
| Family fee range (average of state fees) | $2.68–$235.64 |
| Rural fee uplift | — |
Who bills Q4042 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 338 |
| Medicare beneficiaries | 378 |
| States with claims | 13 |
| Share of services in top 3 states (California, Florida, Oklahoma) | 40% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4042, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 530 | 497 | $36.28 | $27.89 |
| 2023 | 539 | 498 | $38.47 | $29.78 |
| 2024 | 418 | 378 | $39.84 | $30.64 |
States with the most Q4042 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 53 | $31.15 |
| Florida | 31 | $31.84 |
| Oklahoma | 27 | $30.31 |
| Texas | 26 | $32.25 |
| Oregon | 20 | $25.38 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: Data |
| practitioner claims | 2 | Clinical: Data |
What changed for Q4042
- 2026-01-01: Average state fee rose 2.0%: $42.64 to $43.49
- 2001-07-01: Q4042 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 Q4042?
Q4042 is the HCPCS Level II code for cast supplies, long leg splint, adult (11 years +), fiberglass. Short descriptor: "Cast sup lng leg splnt fbrgl".
How much does Medicare pay for Q4042?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $43.49. Rural fees can be higher.
Does Medicare cover Q4042?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for Q4042 change in 2026?
The average non-rural state fee moved from $42.64 in 2025 to $43.49 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of Q4042 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)
- Q4004 — Cast supplies, shoulder cast, adult (11 years +), fiberglass ($155.03–$155.03)
- 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)
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 Q4042
- Watch Q4042 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4042
Sources: CMS HCPCS Level II release October 2026; 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.