Summary & Overview
CPT 29355: Application of Long Leg Cast (Thigh to Toes)
CPT code 29355: Application of long leg cast (thigh to toes) is a widely utilized procedure in orthopedic surgery for immobilizing the lower extremity after fractures or injuries. This code is relevant across the United States, reflecting standard care practices in both ambulatory and office-based settings. The procedure is essential for ensuring proper healing and alignment of the leg, particularly following tibial fractures.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for CPT code 29355. The publication provides a comprehensive overview of payer coverage, clinical context, and policy benchmarks related to this code. Readers will gain insights into typical use cases, associated diagnoses, and relevant modifiers, as well as comparisons to related CPT codes such as 29345 and 29358.
Key topics include the clinical indications for long leg cast application, payer-specific coverage policies, and the role of this procedure in orthopedic trauma and sports medicine. The summary also highlights the importance of accurate coding and documentation for optimal reimbursement and compliance. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on CPT code 29355 and its place in orthopedic care.
CPT Code Overview
CPT code 29355 describes the application of a long leg cast, extending from the thigh to the toes. This procedure is commonly performed in the field of orthopedic surgery to immobilize the lower extremity following fractures or other injuries. The typical site of service for this procedure is an ambulatory setting, most often an office environment (Place of Service 11). The application of a long leg cast is a critical intervention for ensuring proper healing and alignment of the affected limb.
Clinical & Coding Specifications
Clinical Context
A patient presents to an orthopedic surgery clinic after sustaining a closed fracture of the tibia, either at the shaft or lower end, or a pathological fracture. The orthopedic surgeon evaluates the injury and determines that immobilization with a long leg cast (from thigh to toes) is necessary to promote healing and prevent further injury. The procedure is performed in an ambulatory setting, such as an office (Place of Service 11). The cast is applied by the orthopedic provider, ensuring proper alignment and immobilization of the affected limb. The workflow includes assessment, imaging confirmation, cast application, and post-procedure instructions for care and follow-up.
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 | Orthopedic Surgery |
| 207XX0004X | Orthopaedic Trauma |
| 207XS0117X | Surgical Sports Medicine |
- Specialty Representation:
- Orthopedic Surgery: Providers specializing in surgical and non-surgical treatment of musculoskeletal conditions.
- Orthopaedic Trauma: Providers focused on acute musculoskeletal injuries and trauma care.
- Surgical Sports Medicine: Providers specializing in surgical management of sports-related injuries.
Related Diagnoses
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S82.401A- Unspecified fracture of lower end of right tibia, initial encounter for closed fracture- Relevant for patients with a closed fracture at the lower end of the right tibia requiring immobilization with a long leg cast.
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S82.402A- Unspecified fracture of lower end of left tibia, initial encounter for closed fracture- Indicates a closed fracture at the lower end of the left tibia, appropriate for cast application.
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S82.301A- Unspecified fracture of shaft of right tibia, initial encounter for closed fracture- Used when the fracture is located at the shaft of the right tibia and immobilization is needed.
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S82.302A- Unspecified fracture of shaft of left tibia, initial encounter for closed fracture- Applies to fractures at the shaft of the left tibia, requiring a long leg cast.
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M84.461A- Pathological fracture, right tibia, initial encounter- Indicates a pathological fracture of the right tibia, where cast application is part of the initial management.
Related CPT Codes
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29345- Application of long leg cast- This code represents the application of a long leg cast, similar to
29355, but may differ in technique or complexity. It is often used as an alternative depending on clinical circumstances.
- This code represents the application of a long leg cast, similar to
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29358- Application of long leg brace type cast- This code is used for the application of a brace-type long leg cast. It may be selected as an alternative to
29355when a brace-type immobilization is clinically indicated.
- This code is used for the application of a brace-type long leg cast. It may be selected as an alternative to
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Clinical Workflow Relation:
29345and29358are related to29355as alternative procedures for immobilizing the lower extremity. They are not typically used together but may be selected based on the specific injury and provider preference.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 29355 is $159.26 for Medicare, while the average commercial mean rate (BUCA) is $173.97. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, at $230.14 and $213.71 respectively, compared to Medicare.
Rate dispersion varies significantly across payers. Medicare shows the tightest range between the 25th and 75th percentiles ($17.00), indicating less variability in reimbursement. In contrast, UnitedHealth Group exhibits the widest range ($135.33), followed by Cigna ($117.75), reflecting greater variability in commercial rates. Blue Cross Blue Shield and BUCA also show moderate dispersion, while Aetna has a narrower spread.
The table and chart below present a detailed breakdown of national mean rates and percentile distributions for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.