How much does Medicare pay for HCPCS Q4038?

Medicare allowed an average of $47.92 per service and paid $37.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $120.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q4038?

Cast supplies, short leg cast, adult (11 years +), fiberglass. It was billed 17,961 times to 10,370 Medicare beneficiaries by 493 providers in 2024.

Which specialty bills Q4038 most?

Orthopedic Surgery, with 8,223 services from 240 clinicians. Next are Podiatry, Physician Assistant, Nurse Practitioner.

HCPCS Q4038

Cast supplies, short leg cast, adult (11 years +), fiberglass

$47.92Medicare-allowed amount per service, averaged across 17,961 services

Providers submitted

$120.69

Asking price, not received

Medicare allowed

$47.92

The fee schedule figure

Medicare paid

$37.16

Balance is patient coinsurance

Providers submitted an average of $120.69 for this code and Medicare allowed $47.92 — 2.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $37.16 (78%); the rest is the patient’s coinsurance and deductible.

Services: 17,961
Beneficiaries: 10,370
Providers billing it: 493
Total allowed: $860,691

What Medicare pays for HCPCS Q4038

Across 17,961 services billed by 493 providers to 10,370 beneficiaries, Medicare allowed an average of $47.92 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills Q4038

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	8,223	5,147	$47.95	240
Podiatry	5,811	2,717	$47.46	133
Physician Assistant	2,394	1,768	$48.58	86
Nurse Practitioner	922	633	$48.58	29
Internal Medicine	421	14	$47.61	1
Preventive Medicine	85	40	$49.44	1
Sports Medicine	63	28	$49.44	1
Hand Surgery	26	11	$49.47	1
Certified Clinical Nurse Specialist	16	12	$49.44	1

Q4038 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,091	$46.24	$38.66	56
Texas	1,684	$48.55	$38.40	40
New Jersey	1,222	$49.14	$38.64	15
Arizona	1,055	$48.78	$38.49	23
Florida	826	$49.15	$38.87	28
Tennessee	807	$48.56	$38.33	18
Oklahoma	671	$48.10	$39.00	7
North Carolina	666	$49.11	$38.15	20
Missouri	600	$48.48	$38.75	12
Alabama	546	$46.38	$38.55	16
Washington	511	$48.58	$38.05	18
Virginia	501	$48.77	$38.84	13
Ohio	479	$48.96	$37.76	19
South Carolina	460	$45.32	$37.32	19
Mississippi	454	$47.75	$38.16	14
Illinois	423	$48.59	$38.50	15
Colorado	400	$48.88	$37.96	14
Pennsylvania	386	$48.58	$38.48	11
New York	380	$48.16	$37.96	9
Indiana	339	$46.28	$38.43	8
Kansas	315	$49.36	$37.70	8
Georgia	302	$46.21	$38.62	12
New Hampshire	290	$44.98	$39.39	5
Kentucky	261	$46.25	$38.58	11
Michigan	250	$46.35	$37.14	6
Louisiana	242	$48.93	$38.86	7
Iowa	223	$46.50	$39.26	8
Arkansas	200	$49.24	$37.86	3
Oregon	199	$47.75	$38.00	10
Connecticut	170	$48.92	$38.03	6
Wisconsin	157	$41.51	$38.76	5
Massachusetts	156	$49.45	$38.74	7
Maryland	154	$48.60	$38.50	6
Alaska	79	$40.05	$38.23	2
New Mexico	78	$46.26	$37.59	3
Minnesota	59	$49.45	$38.72	4
Utah	59	$49.48	$37.39	3
Nebraska	59	$49.45	$38.72	3
South Dakota	48	$48.44	$37.95	2
Hawaii	38	$46.12	$39.91	2
Delaware	38	$49.46	$38.35	1
Montana	31	$49.47	$38.12	1
Rhode Island	28	$49.50	$36.58	2
Idaho	24	$49.44	$39.39	1

Related codes

Q4010Cast supplies$23.01
Q4022Cast supplies$14.44
Q4037Cast supplies$19.43
Q4049Finger splint$2.51
Q4046Cast supplies$21.80
Q4021Cast supplies$8.05
Q4014Cast supplies$31.42

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.