Q4042 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for ~Cast sup lng leg splnt fbrgl.
Q4042 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $42.64 | $42.64 | $42.64 | $42.64 | $43.49 | $43.49 |
⚠️ This is a National Estimate
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Code Description
Cast supplies, long leg splint, adult (11 years +), fiberglass
Reimbursement Summary
CPT code Q4042 (Cast supplies, long leg splint, adult (11 years +), fiberglass) had a 2026 Medicare non-facility reimbursement rate of $43.49. This reflects a 1.99% change from the prior year.
The 2026 National Medicare reimbursement estimate for Q4042 is $43.49. Actual payment can vary by locality, setting, and claim specifics.
Description: Cast supplies, long leg splint, adult (11 years +), fiberglass. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q4042 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $42.64 | $42.64 | $42.64 | $42.64 | $43.49 | $43.49 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $43.49 | $43.49 | +1.99% | +1.99% |
| 2026 Q1 | $43.49 | $43.49 | +1.99% | +1.99% |
| 2025 Q4 | $42.64 | $42.64 | — | — |
| 2025 Q3 | $42.64 | $42.64 | — | — |
| 2025 Q2 | $42.64 | $42.64 | — | — |
| 2025 Q1 | $42.64 | $42.64 | — | — |
Commercial Payer Rates for Q4042
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For Q4042 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for Q4042?
The 2026 National Average Medicare reimbursement rate for Q4042 (DMEPOS Equipment) is $43.49. This rate is effective as of January 1, 2026.
What is the description for code Q4042?
Cast supplies, long leg splint, adult (11 years +), fiberglass
Why do facility and non-facility payments differ for Q4042?
Facility vs. non-facility differences usually apply to RVU-based physician services. Q4042 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for Q4042?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is Q4042 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
