In this paper we study the problem of prescribing fractional Q-curvature of order \(2\sigma \) for a conformal metric on the standard sphere \(\mathbb {S}^n\) with \(\sigma \in (0,n/2)\) and \(n\ge 3\) . Compactness and existence results are obtained in terms of the flatness order \(\beta \) of the prescribed curvature function K. Making use of integral representations and perturbation result, we develop a unified approach to obtain these results when \(\beta \in [n-2\sigma ,n)\) for all \(\sigma \in (0,n/2)\) . This work generalizes the corresponding results of Jin-Li-Xiong (Math Ann 369:109–151, 2017) for \(\beta \in (n-2\sigma ,n)\) .