HCPCS Level II Q4004: Shoulder Cast Supply, Adult Fiberglass - OpenPayer

Summary & Overview

HCPCS Level II Q4004: Shoulder Cast Supply, Adult Fiberglass

HCPCS Level II code Q4004 identifies fiberglass cast supplies for adult shoulder immobilization (patients aged 11 years and older). This supply code matters nationally because it standardizes billing for a common orthopedic material used across emergency departments, orthopedic clinics, outpatient surgical centers, and durable medical supply workflows. Accurate coding supports consistent reimbursement, inventory management, and clinical documentation for shoulder fractures, dislocations, and postoperative immobilization.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what Q4004 represents, typical sites of service, and the clinical contexts in which the supply is used. The publication also summarizes benchmarks and policy-relevant considerations affecting billing and coverage for cast supplies, highlights common modifier usage (listed separately), and clarifies where input data are unavailable.

Intended readers include billing professionals, orthopedic clinicians, practice managers, and policy analysts seeking a national, payer-agnostic explanation of this HCPCS Level II supply code and its operational implications.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4004HCPCS Level IIshoulder castfiberglass castorthopedicsoutpatient servicesmedical suppliescasting supplies

Billing Code Overview

HCPCS Level II code Q4004 describes cast supplies, shoulder cast, adult (11 years +), fiberglass. This item represents the materials used to fabricate a shoulder immobilization cast for adult patients, using fiberglass as the primary casting material.

Service Type: Cast supply — shoulder immobilization

Typical Site of Service: Outpatient clinic, orthopedic clinic, emergency department, ambulatory surgical center, or other outpatient settings where cast application and supplies are provided.

Clinical & Coding Specifications

Clinical Context

A 45-year-old adult presents to an orthopedic clinic and emergency department with acute shoulder pain and deformity after a fall onto the outstretched arm. Physical exam demonstrates tenderness, limited active range of motion, and a suspected proximal humerus fracture confirmed by shoulder radiographs. The orthopedic clinician performs closed reduction (if indicated) and applies a fiberglass shoulder cast for immobilization of the glenohumeral complex and proximal humerus. The supply billed is Q4004 (Cast supplies, shoulder cast, adult (11 years +), fiberglass). Typical workflow: initial evaluation and imaging, informed consent, fracture reduction if required, molding and application of the fiberglass shoulder cast using Q4004 supplies, patient education on cast care and follow-up scheduling for orthopedic clinic for repeat imaging and cast assessment within 1–2 weeks.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use if the cast application required substantially greater effort or complexity than typical (document reason).
`23`

HCPCS Level II Q4403: Xwrap Dual Plus, Wound Care Add-On

HCPCS-Q4344-TRI-MEMBRANE-WRAP-ADD-ON-PER-CM

HCPCS Q4344: Tri-membrane Wrap, Per Square Centimeter

HCPCS-Q5156-TOCILIZUMAB-ANOH-AVTOZMA-INJECTION-1MG

HCPCS Level II Q5156: Tocilizumab-anoh (Avtozma) Injection, 1 mg

HCPCS-Q2054-LISOCABTAGENE-MARALEUCEL-CAR-T-THERAPY

HCPCS Q2054: Lisocabtagene Maraleucel CAR-T Therapy

HCPCS-Q2036-INFLUENZA-VACCINE-FLULAVAL-IM-IN-AGE-3-PLUS

HCPCS Q2036: Influenza Vaccine (Flulaval) IM for Ages 3+

HCPCS-Q4011-PEDIATRIC-SHORT-ARM-PLASTER-CAST-SUPPLIES

HCPCS Q4011: Pediatric Short Arm Plaster Cast Supplies

HCPCS-Q4152-DERMAPURE-PER-SQ-CM-ADD-ON

HCPCS Level II Q4152: Dermapure, Per Square Centimeter (Add-on)

HCPCS-Q4221-AMNIOWRAP2-PER-SQUARE-CENTIMETER

HCPCS Q4221: Amniowrap2, Biologic Matrix Per Sq Cm

HCPCS-Q5136-DENOSUMAB-BIOSIMILAR-INJECTION-1MG

HCPCS Q5136: Denosumab-bbdz (Jubbonti/Wyost) Injection, 1 mg

HCPCS-Q5117-TRASTUZUMAB-ANNS-KANJINTI-10MG-INJECTION

HCPCS Q5117: Trastuzumab-anns (Kanjinti) Injection, 10 mg

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Primary specialty applying shoulder casts and managing fractures.
`207RA0000X`	Reconstructive Orthopedics	Specialists involved in complex shoulder fracture management and immobilization.
`208D00000X`	Emergency Medicine	Initial evaluation, reduction, and temporary shoulder immobilization in ED.
`363A00000X`	Physician Assistant	Common provider assisting in cast application under physician supervision.
`367500000X`	Nurse Practitioner	APPs who frequently perform cast application and patient education.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S42.21XA`	Fracture of surgical neck of right humerus, initial encounter for closed fracture	Proximal humerus fractures commonly require shoulder immobilization with an adult fiberglass shoulder cast.
`S42.22XA`	Fracture of surgical neck of left humerus, initial encounter for closed fracture	Same as above for the left shoulder.
`S43.01XA`	Anterior dislocation of right shoulder, initial encounter	Shoulder dislocations often require reduction and subsequent immobilization with a shoulder cast or sling.
`S43.02XA`	Anterior dislocation of left shoulder, initial encounter	As above for the left side.
`S42.001A`	Fracture of upper end of right humerus, unspecified part, initial encounter for closed fracture	Other proximal humeral fracture patterns that may be immobilized with a shoulder cast.
`M75.1`	Rotator cuff tear or rupture, not specified as traumatic	In select cases post-repair or for immobilization after certain procedures, shoulder casts may be used temporarily.
`S42.209A`	Fracture of upper end of humerus, unspecified side, initial encounter for closed fracture	General proximal humerus fracture code used when side not specified; relates to cast immobilization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`23605`	Closed treatment of humeral shaft fracture; without manipulation, with or without traction, with or without internal or external fixation	May precede or follow shoulder immobilization when closed management of proximal humerus fractures is performed; cast applied for immobilization.
`23606`	Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction, with or without internal or external fixation	Used when closed reduction with manipulation is performed prior to shoulder cast application.
`20690`	Drainage of hematoma; spontaneous or post-traumatic	Performed if significant post-injury hematoma requires drainage before cast application.
`73030`	Radiologic examination, shoulder; complete, minimum of two views	Ordered before and after cast application to document fracture alignment and cast placement.
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the office visit or procedure	Sometimes used for billing additional non-standard supplies not encompassed by `Q4004` when applicable.

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