Summary & Overview
CPT 29435: Lower Extremity Cast Application (Below Knee to Hip)
CPT code 29435 is a nationally recognized billing code for the application of a lower extremity cast, extending from below the knee to the hip, and includes the provision of a knee immobilizer or walking boot for each leg. This procedure is essential in orthopedic care for immobilizing fractures and injuries to the leg, facilitating proper healing and recovery. The code is most frequently utilized in office or outpatient settings, reflecting its role in non-emergent, ambulatory care environments.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding coverage and reimbursement policies for CPT code 29435 is critical for providers and billing professionals, as it impacts claims processing and financial outcomes across the healthcare system.
This publication provides a comprehensive overview of CPT code 29435, including clinical context, payer coverage, and related policy updates. Readers will gain insight into national benchmarks, relevant modifiers, associated diagnoses, and related CPT codes. The analysis also highlights the importance of accurate coding and documentation for orthopedic procedures involving cast application. By reviewing this summary, stakeholders can stay informed about evolving payer requirements and industry standards for lower extremity cast application.
CPT Code Overview
CPT code 29435 describes the application of a cast to the lower extremity, specifically from below the knee to the hip level. This procedure includes the use of one knee immobilizer or walking boot for each leg. It is classified as a surgical service under the category of application of casts and strapping for the lower extremity. The typical site of service for this procedure is an office or outpatient setting, such as place of service 11. This code is commonly used in orthopedic practices to immobilize the leg following fractures or other injuries requiring stabilization.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office or outpatient clinic with a closed fracture of the lower end or shaft of the tibia, or a pathological fracture of the tibia. The provider evaluates the injury and determines that immobilization is required for proper healing. The clinical workflow involves the application of a cast extending from below the knee to the hip level, which may include a knee immobilizer or walking boot for each leg. The procedure is performed by an orthopaedic surgeon or a provider with expertise in musculoskeletal injuries. The cast ensures stabilization of the fracture site and facilitates recovery, with follow-up visits scheduled to monitor healing and adjust immobilization as needed.
Coding Specifications
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Modifiers:
Modifier Code Description When to Use LTLeft side When the cast is applied to the left lower extremity RTRight side When the cast is applied to the right lower extremity