Q4026 Hip Spica (HCPCS) Reimbursement & Policy

HCPCS Level II code Q4026 identifies fiberglass cast supplies for an adult hip spica (one or both legs). This supply-level code is used when a hip spica cast is applied to immobilize the hip and one or both lower extremities, typically in post-operative care, fracture management, or certain orthopedic procedures. Nationally, supply-specific HCPCS codes like Q4026 matter for accurate billing, inventory tracking, and consistent reporting across inpatient and outpatient orthopedic services.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and typical sites of service, followed by benchmarks and payer-specific coverage patterns where available. The publication highlights how Q4026 is positioned within supply billing for casting procedures and what administrative fields commonly accompany its use.

This summary provides clinicians, billing staff, and policy analysts with: a clear definition of the service represented by the code, the typical care settings where it applies, and an outline of the payer landscape covered. Data not available in the input include specific ICD-10 pairings, associated taxonomies, related codes, and detailed payer policy language.

Billing Code Overview

HCPCS Level II code Q4026 represents cast supplies for hip spica for adults (age 11 years and older) using fiberglass material. This code describes the supply component specifically designated for a hip spica cast that immobilizes one or both legs and the pelvic/hip region.

Service type: Orthopedic immobilization supply
Typical site of service: Hospital inpatient, hospital outpatient, ambulatory surgical center, orthopedic clinic, or other settings where casting and post-operative immobilization are provided

Clinical Context

An adult patient (age 11 years and older) presents to an orthopedic clinic or ambulatory surgical center with a femoral fracture or post-operative need for immobilization requiring a hip spica fiberglass cast. Typical scenarios include surgical fixation of a proximal femur, acetabular fracture management requiring temporary immobilization, or nonoperative treatment of complex femoral shaft fractures where hip-pelvis immobilization is indicated. The clinical workflow: initial evaluation in clinic or emergency department with imaging confirms the indication for hip spica immobilization; orthopedic surgeon or cast technician applies a pre-fabricated or custom Q4026 fiberglass hip spica (one or both legs) in a procedure room or cast room; documentation includes indication, limb(s) immobilized, materials used (fiberglass), time of application, patient tolerance and cast care instructions; follow-up visits evaluate skin integrity, cast fit, neurovascular status, and need for cast modification or removal. Typical sites of service are orthopedic clinic cast room, ambulatory surgery center, hospital outpatient department, or emergency department depending on clinical acuity.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use if separate hip spica components are applied to both lower extremities and payor requires bilateral reporting.

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopedic Surgery	Primary specialty applying or ordering hip spica casts.
`163W00000X`	Physical Medicine & Rehabilitation	Manages immobilization outcomes and follow-up care.
`174400000X`	Emergency Medicine	Applies temporary immobilization in the ED prior to definitive care.
`332B00000X`	Orthotic/Prosthetic Supplier	Supplies and fits custom components or padding for cast application.
`231H00000X`	Pediatric Medicine	In institutions where adolescent/young adult orthopedic care is provided (age 11+), pediatricians may coordinate care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.301A`	Unspecified fracture of right femur, initial encounter for closed fracture	Femoral fractures commonly require hip spica immobilization when proximal femur or shaft injuries need pelvic stabilization.
`S72.302A`	Unspecified fracture of left femur, initial encounter for closed fracture	Same clinical relevance for left-sided fractures requiring hip spica.
`S72.001A`	Fracture of head of right femur, initial encounter for closed fracture	Proximal femur fractures may need immobilization with a hip spica in certain nonoperative or preoperative situations.
`S32.441A`	Displaced sacral fracture, initial encounter for closed fracture	Pelvic or sacral fractures with hip involvement sometimes require hip spica immobilization for stabilization.
`M84.361A`	Pathologic fracture, right femur, initial encounter for fracture	Pathologic femur fractures may be immobilized with a hip spica in nonoperative management or palliative settings.
`S72.941A`	Unspecified fracture of femur, unspecified, initial encounter for closed fracture	General femoral fracture code applicable when hip spica immobilization is part of management.
`M16.11`	Unilateral primary osteoarthritis, right hip	Severe hip degenerative disease with instability or post-procedural immobilization needs may utilize a hip spica temporarily.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29325`	Application of hip spica cast (one or both legs), infant or child	Similar procedure for pediatric patients; describes the casting technique and may guide documentation for hip spica application in younger patients though `Q4026` is a supply code for adults.
`29075`	Application of long arm cast, shoulder to hand; with or without removal of existing cast	Example of casting procedure codes used for other long-limb immobilizations and useful as a documentation analog for casting technique and time; may be used for concurrent upper extremity immobilization.
`29515`	Application of short leg cast, walking, any type	Represents lower extremity cast application codes commonly billed alongside lower limb immobilization procedures for contralateral injuries.
`99070`	Supplies and materials (except spectacles), noncovered items, used during patient care, list materials	Generic supply code sometimes used by payors if a specific HCPCS supply code is not covered; relates to `Q4026` as an alternative supply billing entry.
`99090`	Analysis of clinical data stored in an electronic health record	Used when documentation of serial cast checks and measurements are billed under time/monitoring services in complex care pathways involving immobilization.

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Summary & Overview

HCPCS Q4026: Cast Supplies, Hip Spica (Adult), Fiberglass