CPT 29049: Figure-of-Eight Cast Application for Upper Extremity

CPT code 29049 denotes the application of a figure-of-eight cast to immobilize an upper-extremity structure, most often used after operative management of arm or forearm fractures. Nationally, this code is relevant to orthopaedic surgeons, trauma teams, and ambulatory surgical services due to its role in postoperative immobilization and fracture stabilization. Proper coding supports accurate procedure reporting and facility/provider payment classification.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes typical clinical contexts where the cast is applied, common associated diagnoses such as shaft and distal radius fractures, and related orthopaedic casting codes for shoulder, elbow, and hand immobilization.

Readers will find concise benchmarks for coding practice, an explanation of clinical indications and typical sites of service, and comparison to nearby casting codes to aid code selection. The material outlines documentation elements tied to the procedure description and links the code to common postoperative scenarios. Data not available in the input is noted where applicable. This resource is intended for coding professionals, revenue cycle staff, and clinicians seeking a clear statement of clinical intent and coding context for 29049.

Billing Code Overview

CPT code 29049 describes the application of a figure-of-eight cast used to immobilize an upper-extremity structure, typically following surgery. The technique involves applying cast material so that one turn of the wrapping crosses another in the center, producing the appearance of the numeral eight.

Service type: Cast application for immobilization after a surgical procedure
Typical site of service: Ambulatory surgical center or hospital outpatient/operating room setting; may also be applied in an emergency department or procedural clinic following operative management

Clinical Context

A 45-year-old patient presents to the orthopedic clinic after closed reduction of an acute distal radius fracture of the right wrist sustained in a fall. Under regional anesthesia in a procedure room, the surgeon completes fracture reduction and applies a figure-of-eight plaster cast to immobilize the forearm and distal humerus segments for optimal alignment and to protect the reduction. The typical workflow includes: pre-procedure consent and history, closed reduction under local/regional or monitored anesthesia care, confirmation radiographs, application of the 29049 figure-of-eight cast by the provider or casting technician under direct supervision, patient instruction on cast care and activity restrictions, and scheduling follow-up visit with repeat radiographs within 7–14 days.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when the cast application is partially reduced in scope compared with full procedure (e.g., limited molding due to patient factors).
`53`	Discontinued procedure	Use if the attempt to apply the figure-of-eight cast was started but aborted prior to completion.

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty providing operative and post-operative fracture care and cast application.
`207XX0004X`	Orthopaedic Trauma	Subspecialty focused on acute fracture management relevant to complex fracture immobilization.
`207XS0117X`	Surgery of the Hand	Relevant when fractures involve the distal radius, forearm, or hand and require specialized casting techniques.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S42.401A`	Unspecified fracture of shaft of humerus, right arm, initial encounter for closed fracture	Humeral shaft fractures may require figure-of-eight or similar immobilization following reduction or surgical fixation to maintain alignment.
`S42.402A`	Unspecified fracture of shaft of humerus, left arm, initial encounter for closed fracture	Same clinical relevance for left-sided humeral shaft injuries.
`S52.501A`	Unspecified fracture of the lower end of right radius, initial encounter for closed fracture	Distal radius fractures commonly receive figure-of-eight or forearm casting after reduction to stabilize the wrist and distal forearm.
`S52.502A`	Unspecified fracture of the lower end of left radius, initial encounter for closed fracture	Same relevance for left-sided distal radius fractures.
`S52.91XA`	Unspecified fracture of right forearm, initial encounter for closed fracture	General forearm fractures where a figure-of-eight cast may be applied to control rotational forces and immobilize the fracture.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29055`	Application, cast, shoulder spica	Alternative immobilization when shoulder and proximal humerus stabilization is required instead of a figure-of-eight cast.
`29058`	Application, cast, plaster Velpeau	Alternative for upper arm/shoulder immobilization; used when axillary immobilization is preferred.
`29065`	Application, cast, shoulder to hand long arm	Used when longer immobilization from shoulder to hand is required instead of the more localized figure-of-eight.
`29075`	Application, cast, elbow to finger short arm	Used for forearm and wrist immobilization when a short arm cast is indicated rather than a figure-of-eight.
`29085`	Application, cast, hand & lower forearm gauntlet	Used for hand and distal forearm injuries when a gauntlet cast is more appropriate.
`29086`	Application, cast, finger	Used when isolated digit immobilization is required instead of an arm or forearm cast.

OpenPayer

Summary & Overview