Summary & Overview
CPT 29305: Application of Hip Spica Cast
CPT code 29305 covers the application of a hip spica cast, a critical procedure in orthopaedic surgery for immobilizing the hip and thigh following fractures or injuries. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The hip spica cast is typically applied in an office setting and is essential for both pediatric and adult patients requiring stabilization of the lower extremity.
This publication provides a comprehensive overview of 29305, including payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the procedural details, typical sites of service, and the role of this code in musculoskeletal surgical care. The summary also highlights associated modifiers and taxonomies relevant to orthopaedic practice, as well as common ICD-10 diagnoses linked to hip spica cast application. Policy updates and coding trends are discussed to inform stakeholders about current practices and reimbursement considerations. The analysis is designed for a national audience, offering clarity on payer policies and clinical utilization of this important orthopaedic procedure.
CPT Code Overview
CPT code 29305 represents the application of a hip spica cast, a procedure commonly performed as part of surgical interventions on the musculoskeletal system. This service is typically provided in an office setting (Place of Service 11) and is used to immobilize the hip and thigh, often following fractures or other injuries requiring stabilization. The hip spica cast is essential in pediatric and adult orthopaedic care for ensuring proper healing and alignment after trauma or surgery.
Clinical & Coding Specifications
Clinical Context
A pediatric patient presents to the office (Place of Service 11) with a closed fracture of the lower end or shaft of the tibia, as indicated by ICD-10 codes such as S82.401A, S82.402A, S82.301A, or S82.302A. The patient may also have a pathological fracture (M84.461A). The orthopaedic surgeon evaluates the injury and determines that immobilization with a hip spica cast is necessary to ensure proper healing and alignment. The procedure involves the application of a hip spica cast, which immobilizes the hip and affected leg, typically performed by an orthopaedic specialist in the office setting. Documentation includes laterality, fracture type, and encounter status.
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 |
| 207XX0004X | Orthopaedic Trauma |
| 207XS0117X | Sports Medicine (Orthopaedic Surgery) |
- Specialties Represented:
- Orthopaedic Surgery: General musculoskeletal surgical care
- Orthopaedic Trauma: Management of traumatic musculoskeletal injuries
- Sports Medicine (Orthopaedic Surgery): Musculoskeletal care related to sports injuries
Related Diagnoses
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S82.401A: Unspecified fracture of lower end of right tibia, initial encounter for closed fracture- Indicates a new, closed fracture at the lower end of the right tibia, relevant for immobilization with a hip spica cast.
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S82.402A: Unspecified fracture of lower end of left tibia, initial encounter for closed fracture- Indicates a new, closed fracture at the lower end of the left tibia, requiring immobilization.
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S82.301A: Unspecified fracture of shaft of right tibia, initial encounter for closed fracture- Represents a closed fracture of the right tibial shaft, often managed with casting.
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S82.302A: Unspecified fracture of shaft of left tibia, initial encounter for closed fracture- Represents a closed fracture of the left tibial shaft, relevant for hip spica cast application.
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M84.461A: Pathological fracture, right tibia, initial encounter for fracture- Indicates a fracture due to underlying pathology (e.g., bone disease) in the right tibia, requiring immobilization.
Related CPT Codes
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29405: Application of short leg cast (below knee to toes)- Used for immobilization of lower leg fractures; alternative to hip spica cast for less severe injuries.
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29515: Application of short leg splint (calf to foot)- Used for temporary immobilization; may precede casting or be used for less severe injuries.
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27750: Closed treatment of tibial shaft fracture; without manipulation- Represents non-surgical management of tibial shaft fractures; may be performed before or after casting.
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27752: Closed treatment of tibial shaft fracture; with manipulation- Involves realignment of the fracture before immobilization; often followed by cast application.
These codes are related to 29305 as they represent alternative or adjunct procedures for managing tibial fractures. 29405 and 29515 are commonly used as alternatives for less extensive immobilization, while 27750 and 27752 may be used in conjunction with casting for fracture management.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 29305 is $294.24, which is higher than Aetna ($173.48) and Blue Cross Blue Shield ($254.68), but lower than Cigna ($345.66), UnitedHealth Group ($378.42), and the BUCA average ($275.85). The BUCA mean rate, representing the average commercial benchmark, stands at $275.85, slightly below Medicare.
Rate dispersion varies significantly across payers. UnitedHealth Group exhibits the widest spread, with a difference of $218.43 between the 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, Medicare shows the tightest range, with only $32.00 separating its 75th and 25th percentiles, reflecting more consistent reimbursement levels. Cigna and Blue Cross Blue Shield also display considerable dispersion, while Aetna and BUCA are moderately dispersed.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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