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
-
Modifiers
-
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 |
|---|