Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerBilling CodesLower Extremity Application of CastsCPT cpt-29305-hip-spica-body-cast-trunk-and-one-leg
    Ask Trek AI about this page

    CPT 29305: Hip Spica Body Cast for Trunk and One Leg

    Medicare pays $294 and commercial payers pay $399 on average nationally for this procedure.

    CPT code 29305 describes application of a body cast encasing the trunk and one leg down to the ankle or foot (hip spica cast) used to immobilize the hip and thigh to aid healing of hip or proximal femoral/tibial injuries; service type: cast application/immobilization; typical site of service: hospital inpatient or outpatient orthopedic procedure area, ambulatory surgery center, or emergency department depending on clinical setting.

    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.

    Customize your policy alerts

    Sign up for cpt 29305 policy alerts

    Get alerted when payer policies referencing 29305 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Commercial averages sit above Medicare for CPT 29305: Blue Cross Blue Shield's mean ($487.10) and BUCA's mean ($398.90) are both higher than Medicare's mean ($294.20). UnitedHealth Group ($369.80) and Cigna ($337.40) also exceed Medicare, while Aetna's mean ($136.70) falls much lower. This positions Medicare nearer to the mid-to-lower end of national means, with BUCA representing a high-average commercial benchmark relative to Medicare.

    Dispersion varies materially by payer. Blue Cross Blue Shield has the widest interquartile spread at $258.10 (P75 $597.60 minus P25 $381.50), followed by BUCA at $211.10 (P75 $499.20 minus P25 $288.10) and UnitedHealth Group at $233.90 (P75 $466.80 minus P25 $232.90). Aetna shows one of the tightest spreads at $174.00 (P75 $215.80 minus P25 $42.00), and Cigna's spread is $166.40 (P75 $421.90 minus P25 $215.50). Medicare's interquartile range is narrow at $32.00 (P75 $306 minus P25 $274), indicating the least variability among the listed payers.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old female presents to the emergency department after a fall at home with acute left hip and thigh pain and inability to bear weight. Imaging reveals an acute, closed distal tibia fracture and a concomitant displaced proximal femur/hip fracture requiring immobilization. The orthopaedic trauma team examines the patient, confirms neurovascular stability of the lower extremities, and decides to immobilize the torso and the affected lower extremity with a hip spica/body cast that encases the trunk and one leg to the ankle to limit hip and thigh motion prior to definitive surgical fixation. Cast application occurs in the operating room or procedure area under conscious sedation or after regional anesthesia as part of initial fracture management. Typical workflow: initial ED evaluation and imaging, orthopaedic consult, informed consent, anesthesia/sedation as indicated, application of 29305 hip spica/body cast with appropriate padding and documentation of skin condition and neurovascular status, post-procedure imaging as needed, and outpatient or inpatient follow-up for definitive operative planning and cast care instructions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29405Application of short leg cast (below knee to toes)Alternative immobilization for distal tibia fractures when hip/trunk immobilization is unnecessary

    | Application of short leg splint (calf to foot) | Temporary immobilization option in the ED prior to definitive cast or operative fixation

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    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…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    207XX0004X
    207XS0117X
    173C00000X
    2251H1300X
    163WH0500X
    364ST0500X
    2471R0002X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    M84.451APathological fracture, right femur, initial encounter for fracture
    M84.452APathological fracture, left femur, initial encounter for fracture
    M84.459APathological fracture, hip, unspecified, initial encounter for fracture
    M84.461APathological fracture, right tibia, initial encounter for fracture
    M84.462APathological fracture, left tibia, initial encounter for fracture
    M84.469APathological fracture, unspecified tibia and fibula, initial encounter for fracture
    M84.551APathological fracture in neoplastic disease, right femur, initial encounter for fracture
    M84.552APathological fracture in neoplastic disease, left femur, initial encounter for fracture
    M84.559APathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture
    M84.561APathological fracture in neoplastic disease, right tibia, initial encounter for fracture

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Medical Necessity Guidelines Non-Emergency TransportationMass General Brigham Health Plan2026-11-01
    Non-Emergent Transportation Medical PolicyHealth-New-England2026-11-01
    Non-Emergency Facility to Facility Transfershap_caresource_mi_coordinated_health2026-11-01
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    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

    Related Codes

    CPT-29325-HIP-SPICA-BODY-CAST-APPLICATION

    CPT 29325: Hip Spica Cast Application for Hip/Thigh Immobilization

    CPT-29345-LONG-LEG-CAST-APPLICATION-IMMOBILIZATION

    CPT 29345: Long Leg Cast Application, Knee and Leg Immobilization

    CPT-29355-LONG-LEG-AMBULATORY-CAST-APPLICATION

    CPT 29355: Long Leg Ambulatory Cast Application

    CPT-29358-LONG-LEG-BRACE-CAST-FEMUR-FRACTURE-IMMOBILIZATION

    CPT 29358: Long Leg Brace-Type Cast with Knee Motion for Femur Fracture

    CPT-29365-CYLINDER-CAST-LEG-KNEE-IMMOBILIZATION-FRACTURE

    CPT 29365: Thigh-to-Lower-Leg Cylinder Cast Immobilization

    CPT-29405-SHORT-LEG-CAST-LOWER-LEG-FRACTURE-ANKLE-SPRAIN

    CPT 29405: Short Leg Cast for Lower Leg Fracture or Severe Ankle Sprain

    CPT-29425-LOWER-LEG-CAST-APPLICATION-TIBIA-FIBULA-ANKLE

    CPT 29425: Lower Leg Cast Application with Walking Accommodation

    CPT-29435-WALKING-CAST-LOWER-LEG-TIBIA-FIBULA-FRACTURE

    CPT 29435: Lower Leg Walking Cast for Tibia/Fibula Shaft Fracture

    CPT-29440-REMOVABLE-WALKER-OR-HEEL-PAD-FOR-LEG-CAST

    CPT 29440: Removable Walker or Heel Pad Added to Leg Cast

    CPT-29445-TOTAL-CONTACT-WALKING-CAST-FOR-DIABETIC-ULCER-OFFLOADING

    CPT 29445: Total Contact Cast for Diabetic Foot Ulcer

    Showing 1–10 of 11

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    29515

    27750 | Closed treatment of tibial shaft fracture; without manipulation | Nonoperative management pathway that may include casting but does not involve manipulation

    27752 | Closed treatment of tibial shaft fracture; with manipulation | Closed reduction followed by immobilization; may precede or replace 29305 depending on fracture level and need to immobilize the hip/trunk