Summary & Overview
CPT 29055: Shoulder Spica Cast Application
CPT 29055 covers the application of a shoulder spica cast — a semi‑full body cast encasing the chest and one shoulder — used to immobilize the shoulder and proximal arm following fractures, dislocations, or other orthopedic indications. Nationally, this code matters because it documents a specialized immobilization technique that can affect procedural billing, site-of-service determinations, and utilization tracking for orthopedic and trauma care. Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Readers will find a concise explanation of the procedure and typical ambulatory setting, comparisons to related upper‑extremity casting codes, and the common clinical contexts that prompt use of this code (for example, proximal humeral or shoulder‑girdle injuries). The publication highlights billing considerations such as typical modifiers and coding adjacency with related casting services, notes of commonly paired diagnoses, and payer coverage context. Where payer-specific policy details or additional site-of-service rules are required, the report indicates whether those items are available. Data not available in the input is explicitly identified so readers can seek payer policy documents or clinical guidance for local implementation and reimbursement specifics.
CPT Code Overview
CPT 29055 describes the application of a semi‑full body cast encasing the chest and one shoulder (shoulder spica cast). This procedure is an orthopedic casting/immobilization technique used to stabilize the shoulder and proximal upper extremity by immobilizing the chest and one shoulder within a semi‑full body construct. The typical site of service for this procedure is an ambulatory setting, such as an office (Place of Service 11).
Clinical & Coding Specifications
Clinical Context
A patient presents to an ambulatory orthopedic clinic after a traumatic injury to the shoulder and proximal humerus region. Physical exam and radiographs confirm a proximal humerus or shaft humerus fracture requiring immobilization. The clinician performs closed reduction as indicated and applies a semi‑full body cast encasing the chest and one shoulder (shoulder spica cast) to immobilize the shoulder girdle and upper arm. Typical workflow: triage and history, targeted exam, imaging review, informed consent, procedure documentation (indication, technique, laterality), application of 29055 under appropriate analgesia or sedation if needed, post‑procedure neurovascular check, patient education on cast care, and scheduling of follow‑up imaging and clinic visit.
Coding Specifications
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Modifiers
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LT: Used to identify procedures performed on the left side when laterality is required for reporting. -
RT: Used to identify procedures performed on the right side when laterality is required for reporting. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207X00000X | Orthopaedic Surgery |
207XX0004X | Orthopaedic Trauma |
207XS0117X | Surgery of the Hand |
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Notes
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Use laterality modifiers
LTorRTto specify the affected side when applicable for29055. -
If a required taxonomy or modifier is not listed above, statement: "Data not available in the input."
Related Diagnoses
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S42.401A- Unspecified fracture of shaft of humerus, right arm, initial encounter for closed fracture- Clinical relevance: A humeral shaft fracture on the right side may require shoulder spica casting to immobilize the shoulder and upper arm;
29055would be reported withRTwhen applicable.
- Clinical relevance: A humeral shaft fracture on the right side may require shoulder spica casting to immobilize the shoulder and upper arm;
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S42.402A- Unspecified fracture of shaft of humerus, left arm, initial encounter for closed fracture- Clinical relevance: A humeral shaft fracture on the left side may require a shoulder spica cast;
29055would be reported withLTwhen applicable.
- Clinical relevance: A humeral shaft fracture on the left side may require a shoulder spica cast;
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S52.501A- Unspecified fracture of the lower end of right radius, initial encounter for closed fracture- Clinical relevance: While primarily a distal forearm injury, concomitant shoulder immobilization with a spica cast may be clinically indicated in complex upper limb injuries; documentation should support use of
29055.
- Clinical relevance: While primarily a distal forearm injury, concomitant shoulder immobilization with a spica cast may be clinically indicated in complex upper limb injuries; documentation should support use of
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S52.502A- Unspecified fracture of the lower end of left radius, initial encounter for closed fracture- Clinical relevance: As above for the left side; correlate fracture pattern and treatment plan if
29055is billed.
- Clinical relevance: As above for the left side; correlate fracture pattern and treatment plan if
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S52.91XA- Unspecified fracture of right forearm, initial encounter for closed fracture- Clinical relevance: Forearm fractures may coincide with proximal injuries or require shoulder immobilization in specific circumstances; clinical documentation must justify application of
29055for shoulder/upper arm immobilization.
- Clinical relevance: Forearm fractures may coincide with proximal injuries or require shoulder immobilization in specific circumstances; clinical documentation must justify application of
Related CPT Codes
| CPT Code | Description | Relation to 29055 |
|---|---|---|
29049 | Figure‑of‑eight cast to immobilize a structure (arm) | May be used for clavicular or scapular immobilization as a less encompassing alternative; used when shoulder girdle immobilization of lesser extent is appropriate. Common alternative to 29055 for specific clavicle or scapular support. |
29058 | Application of plaster Velpeau cast (upper forearm and shoulder) | Related immobilization technique for shoulder and upper forearm; can be an alternative to 29055 when a Velpeau configuration provides adequate immobilization. May be used in the same clinical pathway as an alternative casting option. |
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Usage notes
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29049and29058can be used as alternatives to29055depending on the injury location and immobilization needs. -
If related CPT code information is missing, statement: "Data not available in the input."
National Reimbursement Benchmarks
Medicare mean allowed rates for CPT 29055 are modestly higher than the BUCA (average commercial) mean, with Medicare at $267.12 versus BUCA at $248.14. This places Medicare above the overall commercial average represented by BUCA but below the highest commercial payers such as UnitedHealth Group and Cigna.
Rate dispersion (P75 − P25) varies across payers. The tightest interquartile ranges are Medicare ($29.00) and Aetna ($76.20), while the widest dispersion appears for UnitedHealth Group ($193.33) and Cigna ($171.25). The table and chart below present the full breakdown of mean rates and percentiles by payer.
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