CPT 29055: Shoulder Spica Semi–Full Body Cast
Medicare pays $267 and commercial payers pay $376 on average nationally for this procedure.
CPT code 29055 describes application of a semi–full body shoulder spica cast that encases the chest and one shoulder to immobilize the shoulder after surgery or to treat shoulder dislocations and injuries; service type: casting/orthopedic immobilization; typical site of service: hospital outpatient department, ambulatory surgery center, or orthopedic clinic.
For related coverage guidance, see recent payer policy updates: Medical Necessity Guidelines Non-Emergency Transportation, Non-Emergent Transportation Medical Policy, Non-Emergency Facility to Facility Transfers.
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National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 29055: BUCA’s mean commercial rate is $375.90 versus Medicare’s mean of $267.10, a gap of $108.80 that highlights material upside in negotiated commercial payments relative to the federal program. Blue Cross Blue Shield and UnitedHealth Group have higher maximums and medians but the illustrative comparison emphasizes that commercial portfolios can deliver substantially higher average reimbursements than Medicare.
Dispersion varies notably by payer. Blue Cross Blue Shield shows a wide interquartile spread (P75–P25 = $167.80), and UnitedHealth Group is also broad (P75–P25 = $208.20), indicating greater variability in commercial contracting. Aetna is among the tightest with a spread of $149.50, while Cigna’s spread is $190.60. BUCA’s interquartile range is $196.50 and Medicare’s is relatively narrow at $29.00, reflecting more consistency in Medicare locality payment buckets.