Summary & Overview
CPT 29035: Application of Body Cast, Shoulder to Hips
CPT code 29035 represents the application of a body cast from the shoulder to the hips, with the option to include the head and neck. This procedure is a critical intervention in orthopedic care, often used to stabilize complex fractures and injuries, particularly in cases involving the upper body. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage across the healthcare landscape.
This publication provides a comprehensive overview of CPT code 29035, detailing its clinical context, typical sites of service, and payer coverage. Readers will gain insights into the procedural benchmarks, relevant policy updates, and the role of this code in orthopedic practice. The analysis also highlights associated modifiers and taxonomies, as well as common ICD-10 diagnoses linked to the procedure. By understanding the nuances of CPT code 29035, healthcare professionals and administrators can better navigate billing, reimbursement, and compliance requirements for orthopedic casting procedures.
CPT Code Overview
CPT code 29035 describes the application of a body cast extending from the shoulder to the hips, and may include the head and neck if performed. This procedure is classified as an orthopedic procedure and is typically performed in a hospital outpatient department (Place of Service 19) or an office setting (Place of Service 11). The body cast is used to immobilize and support the body following significant fractures or injuries, ensuring proper healing and alignment.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital outpatient department or orthopedic office with a closed fracture involving the upper extremity, such as the humerus, radius, or ulna. The injury may be complex, requiring immobilization of the torso and upper limb to ensure proper healing and alignment. The orthopedic physician evaluates the patient, confirms the diagnosis with imaging, and determines that a body cast from the shoulder to the hips (including head/neck if necessary) is required. The cast is applied to stabilize the fracture and prevent movement during the healing process. Follow-up visits are scheduled to monitor healing and adjust the cast as needed.
Coding Specifications
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Modifiers:
LT: Indicates the procedure was performed on the left side.RT: Indicates the procedure was performed on the right side.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207X00000X | Orthopaedic Surgery Physician |
207XX0004X | Orthopaedic Trauma Physician |
207N00000X | Orthopaedic Surgery of the Hand Physician |
- Specialties Represented:
- Orthopaedic Surgery
- Orthopaedic Trauma
- Orthopaedic Surgery of the Hand
Related Diagnoses
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S42.401A: Unspecified fracture of shaft of humerus, right arm, initial encounter for closed fracture- Relevant for patients with a right humerus shaft fracture requiring immobilization with a body cast.
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S52.501A: Unspecified fracture of the lower end of right radius, initial encounter for closed fracture- Indicates a right radius fracture at the lower end, which may necessitate a body cast for stabilization.
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S52.301A: Unspecified fracture of shaft of radius, right arm, initial encounter for closed fracture- Pertains to a shaft fracture of the right radius, often managed with casting.
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S52.201A: Unspecified fracture of shaft of ulna, right arm, initial encounter for closed fracture- Represents a shaft fracture of the right ulna, which may require immobilization with a body cast.
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S42.202A: Unspecified fracture of shaft of humerus, left arm, initial encounter for closed fracture- Applies to left humerus shaft fractures, relevant for body cast application to immobilize the affected area.
Related CPT Codes
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Q4001: Supply code for cast or splint supplies (Level II)- Used to report the materials and supplies required for the application of the body cast described by
29035. Commonly billed together with29035to account for supply costs.
- Used to report the materials and supplies required for the application of the body cast described by
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Q4002: Supply code for cast or splint supplies (Level II)- Also used for cast or splint supplies, may be selected based on the specific materials used. Typically paired with
29035in the clinical workflow to ensure proper reimbursement for supplies.
- Also used for cast or splint supplies, may be selected based on the specific materials used. Typically paired with
Both Q4001 and Q4002 are not alternatives to 29035 but are supply codes that complement the primary procedure code.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 29035 is $310.91, while the BUCA (average commercial) mean rate is $272.70. This places Medicare above the commercial average, with UnitedHealth Group showing the highest mean rate at $375.62 and Aetna the lowest at $164.96 among the major payers.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $37.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group has the widest range at $215.60, reflecting substantial variability in rates. Cigna and Blue Cross Blue Shield also show broad ranges, while Aetna and BUCA are more moderate.
The table and chart below present the full breakdown of national benchmarks for CPT code 29035 across all major payers.
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