ICD-10 S42.4
Non-Billable HeaderFracture of lower end of humerus
About ICD-10-CM S42.4
ICD-10-CM code S42.4 represents Fracture of lower end of humerus. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block S42). The 2026 edition of ICD-10-CM S42.4 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for S42.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under S42.4. Per CMS ICD-10-CM Tabular 2026.
- Fracture of distal end of humerus
Type 2 Excludes
Not included here, the excluded code is not part of S42.4, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- fracture of shaft of humerus (S42.3-)
- physeal fracture of lower end of humerus (S49.1-)
Medicare LCD Coverage for S42.4
Local Coverage Determinations (LCDs) from CMS MACs that list S42.4 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing S42.4.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but S42.4 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with S42.4
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To S42.4
Other codes in section S40-S49 (Injuries to the shoulder and upper arm).
ICD-10 S42.4, Billing FAQ
Is ICD-10 code S42.4 billable? +
No, S42.4 is a non-billable header code. Use a more specific child code from block S42 when submitting claims.
What other names or terms map to S42.4? +
ICD-10 S42.4 includes: Fracture of distal end of humerus.
What codes are Type 2 Excludes for S42.4? +
Type 2 Excludes (may be coded together when both conditions exist): fracture of shaft of humerus (S42.3-); physeal fracture of lower end of humerus (S49.1-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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