CPT 29055: Semi‑Full Body Shoulder Spica Cast Application - OpenPayer

Summary & Overview

CPT 29055: Semi‑Full Body Shoulder Spica Cast Application

CPT code 29055 denotes application of a semi–full body shoulder spica cast that encases the chest and one shoulder to immobilize the shoulder after dislocation, injury, or surgery. This procedure is a key orthopedic immobilization technique used in acute fracture management and postoperative care, with implications for facility resource use, post-procedure care coordination, and coding accuracy nationwide. Major commercial payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, alongside Medicare for federal coverage context.

Readers will find a concise explanation of the clinical role of the shoulder spica cast, typical sites of service where the procedure is performed, and how the code aligns with related upper-extremity immobilization codes. The publication summarizes payer coverage patterns and common claims considerations, highlights coding comparisons with related casts such as figure-of-eight and Velpeau casts, and outlines typical associated diagnoses for which the cast is applied. The material aims to support coding professionals, revenue cycle teams, and orthopedic clinicians in aligning clinical documentation with billing requirements and understanding national coverage contexts and benchmarking information.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare29055CPTshoulder spicaorthopedic castingimmobilizationupper extremity fracturesurgical aftercareprocedure codingambulatory surgery

Billing Code Overview

CPT code 29055 describes the application of a semi–full body cast encasing the chest and one shoulder, commonly known as a shoulder spica cast. This cast is used to immobilize the shoulder and upper thorax, providing stabilization after shoulder dislocations, fractures, or shoulder surgery.

Service type: Immobilization/orthopedic casting procedure

Typical site of service: Hospital inpatient, hospital outpatient (ambulatory surgery), or orthopaedic clinic/procedural suite

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who presents to the orthopaedic clinic or emergency department after a fall or direct blow to the shoulder/upper arm with acute pain, deformity, and limited shoulder motion. Imaging (plain radiographs) confirms a proximal or shaft humerus fracture or associated distal radius/forearm fracture requiring immobilization. After closed reduction or post‑operative care following open reduction and internal fixation, the provider applies a semi–full body shoulder spica cast (29055) encasing the chest and one shoulder to immobilize the glenohumeral joint and proximal humerus. The clinical workflow includes history and exam, radiographic review, consent, cast application (often with padding and plaster or fiberglass), documentation of laterality, neurovascular checks before and after application, and scheduling of follow‑up for cast checks and repeat imaging. Typical sites of service are the orthopaedic outpatient clinic, hospital inpatient unit, or emergency department procedure area depending on timing and acuity.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the shoulder spica is applied to the left side
`RT`

Related Codes

29010

CPT 29010: Application of Risser Jacket Localizer, Body Only

97110

CPT 97110: Therapeutic Exercises for Strength, Endurance, and Flexibility

29505

CPT 29505: Application of Long Leg Splint (Thigh to Ankle or Toes)

97163

CPT 97163: High Complexity Physical Therapy Evaluation

cpt-97537-community-work-reintegration-training

CPT 97537: Community/Work Reintegration Training

cpt-29505-long-leg-splint-application-leg-immobilization

CPT 29505: Long Leg Splint Application for Leg Injuries

97551

CPT 97551: Caregiver Training for Functional Performance, Face-to-Face

29126

CPT 29126: Dynamic Short Arm Splint Application

97760

CPT 97760: Orthotic Management and Training, Initial Encounter

29435

CPT 29435: Lower Extremity Cast Application (Below Knee to Hip)

Showing 1–10 of 191

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty applying shoulder spica casts for fractures and post‑operative immobilization
`207XX0004X`	Orthopaedic Trauma	Specialists managing acute fracture care and complex immobilization
`207XS0117X`	Surgery of the Hand	Relevant when forearm or distal radius fractures coexist and the hand surgeon participates in care

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S42.401A`	Unspecified fracture of shaft of humerus, right arm, initial encounter for closed fracture	Right humeral shaft fractures may require shoulder spica immobilization after reduction
`S42.402A`	Unspecified fracture of shaft of humerus, left arm, initial encounter for closed fracture	Left humeral shaft fractures indicating shoulder immobilization
`S52.501A`	Unspecified fracture of the lower end of right radius, initial encounter for closed fracture	Distal radius fractures may co‑occur; shoulder spica used when concurrent proximal injuries require shoulder immobilization
`S52.502A`	Unspecified fracture of the lower end of left radius, initial encounter for closed fracture	Contralateral distal radius fracture relevance as above
`S52.91XA`	Unspecified fracture of right forearm, initial encounter for closed fracture	Forearm fractures that accompany shoulder or humeral injuries influencing immobilization strategy

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29049`	Figure‑of‑eight cast to immobilize a structure (arm)	Alternative immobilization technique for clavicle or shoulder girdle injuries; may be used instead of a shoulder spica depending on injury
`29058`	Application of plaster Velpeau cast (upper forearm and shoulder)	Alternative or related cast for immobilizing the shoulder and upper forearm; selected based on fracture pattern and surgeon preference