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    v1.0.28
    OpenPayerBilling CodesBody and Upper Extremity Application of CastsCPT cpt-29085-gauntlet-cast-forearm-to-palm-including-thumb
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    CPT 29085: Gauntlet Cast, Forearm to Palm Including Thumb

    Medicare pays $110 and commercial payers pay $176 on average nationally for this procedure.

    CPT code 29085 describes application of a gauntlet cast encasing the forearm to the palm and including the thumb, a form of upper-extremity immobilization used to treat fractures or to protect the wrist and hand after surgical procedures; service type: cast application/orthopedic immobilization; typical site of service: outpatient orthopedic clinic, urgent care, emergency department, or ambulatory surgery center where nonoperative or postoperative casting is performed.

    For related coverage guidance, see recent payer policy updates: Fixed Wing Air Ambulance Transport, Air Ambulance, Ambulance Services (for New Mexico Only).

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    National Reimbursement Benchmarks

    Medicare’s mean rate of $110.4 sits well below BUCA’s commercial-average mean of $176.1, indicating a substantial gap of $65.7 between federal and that commercial benchmark. That gap highlights how commercial averages can be materially higher than Medicare for CPT 29085, with BUCA positioned notably above the federal mean.

    Dispersion varies markedly by payer. Blue Cross Blue Shield shows the widest interquartile spread (P75–P25 = $264.0 - $170.2 = $93.8), followed by Aetna (P75–P25 = $99.0 - $38.0 = $61.0) and UnitedHealth Group (P75–P25 = $183.7 - $92.6 = $91.1). Cigna’s interquartile spread is moderate (P75–P25 = $170.9 - $91.2 = $79.7). BUCA’s IQR is $215.7 - $128.9 = $86.8 and Medicare’s IQR is $115 - $103 = $12, making Medicare the tightest and Blue Cross Blue Shield the widest in this set.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient presents to the emergency department after a fall onto an outstretched hand with acute wrist pain, swelling, and limited thumb motion. Radiographs confirm an acute, closed distal radius fracture of the right wrist (S52.501A). The orthopaedic or emergency medicine clinician performs closed reduction as indicated, then applies a gauntlet (thumb spica) cast encasing the forearm to the palm and including the thumb to immobilize the wrist and first carpometacarpal/thumb metacarpal complex. The procedure is performed in the ED or ambulatory orthopaedic clinic under local or hematoma block anesthesia; post-application neurovascular checks and cast molding are documented. Follow-up is arranged with orthopaedic surgery of the hand for radiographic reassessment and potential definitive management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29065APPLICATION CAST SHOULDER TO HAND LONG ARMAlternative long-arm cast when immobilization must extend to the shoulder/hand; used for more proximal forearm or elbow involvement.
    29075APPLICATION CAST ELBOW TO FINGER SHORT ARM

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    207XX0004XOrthopaedic Foot and Ankle Surgery PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult recons…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    208100000XPhysical Medicine & Rehabilitation PhysicianPhysical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
    133VN1401XPediatric Critical Care Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing med…
    364SR0400XRehabilitation Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    163WP0218XPediatric Oncology Registered NurseNursing Service Providers · Registered Nurse
    103TP0814XPsychoanalysis PsychologistA psychologist whose specialty is distinguished from other specialties by its body of knowledge and its intensive treatment approaches. It aims at str…

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Ambulance TransportProvidence Health Plan2026-07-01
    Air ambulance transport coverage criteriaeocco2026-07-01

    Related Codes

    CPT-29000-HALO-BODY-CAST-APPLICATION-CERVICAL-IMMOBILIZATION

    CPT 29000: Halo-Type Body Cast Application

    CPT-29010-RISSER-JACKET-PREOPERATIVE-SCOLIOSIS-LOCALIZER

    CPT 29010: Risser Jacket (Risser Localizer Cast) Application

    CPT-29015-RISSER-JACKET-PREOPERATIVE-SCOLIOSIS-CAST

    CPT 29015: Risser Localizer Jacket Application for Scoliosis

    CPT-29035-BODY-CAST-TRUNK-SPINE-IMMOBILIZATION

    CPT 29035: Thoracolumbosacral Body Cast for Postoperative Spinal Immobilization

    CPT-29040-MINERVA-BODY-CAST-CERVICAL-THORACIC-STABILIZATION

    CPT 29040: Minerva-Type Body Cast for Cervical and Trunk Stabilization

    CPT-29044-BODY-CAST-SHOULDERS-TO-HIPS-AND-ONE-THIGH

    CPT 29044: Body Cast, Shoulders to Hips and One Thigh

    CPT-29046-TRUNK-AND-SPINE-BODY-CAST-APPLICATION-SHOULDERS-TO-THIGHS

    CPT 29046: Body Cast, Shoulders to Thighs, Trunk/Spine Immobilization

    CPT-29049-FIGURE-OF-EIGHT-CAST-APPLICATION-UPPER-EXTREMITY

    CPT 29049: Figure-of-Eight Cast Application for Arm Immobilization

    CPT-29055-SHOULDER-SPICA-SEMI-FULL-BODY-CAST

    CPT 29055: Shoulder Spica Semi–Full Body Cast

    CPT-29058-PLASTER-VELPEAU-UPPER-FOREARM-SHOULDER-CAST

    CPT 29058: Application of Plaster Velpeau Cast for Upper Forearm and Shoulder

    Showing 1–10 of 13

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Short arm cast option extending to fingers; used for different immobilization length compared with gauntlet/ thumb spica.
    29086APPLICATION CAST FINGERApplied when immobilization is limited to individual digits rather than a gauntlet cast.
    29055APPLICATION CAST SHOULDER SPICAUsed for shoulder/upper arm immobilization in more proximal injuries; not typically used for isolated wrist/hand fractures.
    29058APPLICATION CAST PLASTER VELPEAUUsed for immobilization of the shoulder/arm in specific patterns; alternative upper extremity cast technique.