CPT 29058: Plaster Velpeau Cast, Upper Forearm and Shoulder
CPT code 29058 documents the application of a plaster Velpeau cast that immobilizes the upper forearm and shoulder by securing a flexed forearm against the trunk. Used for fractures of the humerus, scapula, clavicle and for stabilization after closed reduction of glenohumeral, sternoclavicular, or acromioclavicular dislocations, this code captures a common, procedure-driven intervention in acute musculoskeletal care. It matters nationally because immobilization procedures impact emergency and orthopedic workflow, resource use, and post-procedure follow-up care patterns.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 29058, how the service is typically delivered, and where it is performed. The publication summarizes payer coverage considerations and common billing practices, highlights associated procedure code groupings, and outlines clinical indications tied to relevant ICD-10 diagnoses provided in the input. This resource is intended for clinicians, billing professionals, and policy analysts seeking a national-level briefing on coding, clinical use cases, and payer coverage scope for upper-arm Velpeau cast application.
Sign up for cpt 29058 policy alerts
Get alerted when payer policies referencing 29058 are released or updated.
Billing Code Overview
CPT code 29058 describes the application of a plaster Velpeau cast to the upper forearm and shoulder. The cast holds a flexed forearm against the patient's trunk and prevents movement of the shoulder, elbow, and forearm in the treatment of fractures or after closed reduction of dislocations.
Service Type: Cast application / immobilization of upper extremity
Typical Site of Service: Emergency department, urgent care, or orthopedic clinic
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the emergency department after a fall from a ladder with severe right shoulder and proximal arm pain, deformity, and limited shoulder and elbow motion. Radiographs demonstrate a displaced mid-shaft humeral fracture with concern for potential instability; after neurovascular assessment and appropriate analgesia, the orthopaedic or emergency medicine provider performs a closed reduction as indicated and applies a plaster Velpeau (upper forearm and shoulder) cast to immobilize the shoulder and elbow in flexion against the trunk. The cast prevents movement of the glenohumeral, acromioclavicular, and sternoclavicular joints and stabilizes the humerus while soft tissues and the fracture begin to heal. Typical workflow includes pre-procedure informed consent, neurovascular exam documentation, description of reduction maneuvers if performed, application technique and materials used, post-application neurovascular reassessment, cast care instructions documented in the record, and scheduling of follow-up radiographs and clinic evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the Velpeau cast is applied to the left upper extremity |
RT | Right side | When the Velpeau cast is applied to the right upper extremity (note: RT not in provided modifier list; use laterality per payer rules if available) |
50 | Bilateral procedure | When casts are applied to both upper extremities in the same encounter |
52 | Reduced services | When the cast application is partially reduced in scope (e.g., limited application due to patient factors) |
53 | Discontinued procedure | When the cast application was started but discontinued due to patient instability or intolerance |
76 | Repeat procedure by same physician | For a repeat cast application by same provider during the same encounter (not in provided list; omitted if strict list applies) |
78 | Unplanned return to OR for related procedure | If an unplanned return to the operating room is required for a complication related to the cast (e.g., conversion to operative fixation) |
22 | Increased procedural services | When the cast application requires substantially greater work than typical (extensive manipulation, multiple attempts) |
23 | Unusual anesthesia | When general anesthesia or MAC is required for cast application due to patient factors |
59 | Distinct procedural service | To indicate a separate and distinct procedure performed on the same day (not in provided list; use per payer guidance) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopaedic Surgery Physician | Common specialty to perform closed reduction and cast application for humeral or shoulder girdle fractures |
207XX0004X | Orthopaedic Trauma Physician | Subspecialist managing complex fractures and applies immobilization like Velpeau casts |
207P00000X | Emergency Medicine Physician | Often performs initial reduction and cast application in the ED for acute fractures or dislocations |
Note: Only the most clinically relevant modifiers and provided taxonomies are listed. Use payer-specific guidance for laterality and situational modifier application.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S52.501A | Unspecified fracture of the lower end of right radius, initial encounter for closed fracture | Distal radius fractures may coexist with or prompt immobilization decisions; while not the direct indication for a Velpeau cast, documentation supports treatment planning when upper limb injuries are multiple |
S52.502A | Unspecified fracture of the lower end of left radius, initial encounter for closed fracture | Same relevance as S52.501A for the left side; affects selection of cast type if concurrent injuries exist |
S62.501A | Unspecified fracture of the right hand, initial encounter for closed fracture | Hand fractures may alter the need for more distal immobilization versus shoulder-based immobilization |
S62.502A | Unspecified fracture of the left hand, initial encounter for closed fracture | As above for the left hand; informs whether a Velpeau cast is appropriate or a longer/shorter cast is indicated |
M84.431A | Stress fracture, right radius, initial encounter | Stress fractures of the radius may be treated with immobilization; a Velpeau cast could be selected if shoulder/elbow immobilization is clinically necessary |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29055 | APPLICATION CAST SHOULDER SPICA | Alternative immobilization for shoulder girdle injuries when thoracic immobilization is required; used when a spica is preferred over a Velpeau cast |
29065 | APPLICATION CAST SHOULDER TO HAND LONG ARM | More extensive immobilization extending to the hand; used when wrist or hand stabilization is concurrently required |
29075 | APPLICATION CAST ELBOW TO FINGER SHORT ARM | Short arm cast option when injury is distal to the elbow and does not require shoulder immobilization |
29085 | APPLICATION CAST HAND & LOWER FOREARM GAUNTLET | Used for isolated hand or distal forearm fractures when shoulder immobilization is not indicated |
29086 | APPLICATION CAST FINGER | For isolated digital fractures; typically used when only a finger immobilization is required |