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    v1.0.31
    OpenPayerBilling CodesLower Extremity Application of CastsCPT cpt-29345-long-leg-cast-application-immobilization
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    CPT 29345: Long Leg Cast Application, Knee and Leg Immobilization

    Medicare pays $154 and commercial payers pay $322 on average nationally for this procedure.

    CPT code 29345 describes the application of a long leg cast that immobilizes the leg and knee, extending from the thigh over the foot (toes free) for treatment of leg fractures and correction of knee, distal leg, ankle, and foot deformities; service type is cast application/immobilization, and the typical site of service is an ambulatory surgical center, hospital outpatient department, or orthopedic clinic where fracture management and immobilization procedures are performed.

    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 above Medicare for CPT 29345, with BUCA’s mean of $322.20 notably higher than Medicare’s mean of $153.60. This highlights a substantial gap between an average commercial benchmark and the federal program, reflecting different negotiated pricing dynamics and payer mix for this code.

    Dispersion varies meaningfully across payers when measured as P75 minus P25: Blue Cross Blue Shield has the widest interquartile spread at $189.20 (P75 $532.50 minus P25 $353.30), followed by BUCA at $150.30 (P75 $396.20 minus P25 $245.90). UnitedHealth Group shows a spread of $131.10, Cigna $108.80, and Aetna the tightest spread at $92.80. These ranges indicate where commercial reimbursement is most and least variable.

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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 male presents to the emergency department after a motorcycle collision with acute pain, swelling, and deformity of the lower leg. Plain radiographs demonstrate an acute, closed, non-displaced fracture of the midshaft of the right tibia (S82.301A). After neurovascular exam and tetanus status review, the orthopedic provider performs closed reduction as needed and applies a long leg cast to immobilize the knee and tibia while maintaining alignment. The procedure is documented as application of a long leg cast (CPT 29345) extending from the thigh to the foot with toes exposed. The typical clinical workflow includes patient assessment, informed consent, analgesia or conscious sedation if required, closed reduction (if indicated), cast application, post-application neurovascular check, and discharge with cast care instructions and scheduled orthopedic follow-up.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29700-29750Cast removal or repairUsed when cast removal or repair is provided, especially if another physician group originally applied the cast or follow-up requires repair.
    Q4029 through Q4032

    Related Modifiers

    9 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…
    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.,…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    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…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    207XX0004X
    207XS0117X
    364SN0800X
    335U00000X
    163WL0100X
    363LP2300X
    163WG0600X

    Related ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    M84.461APathological fracture, right tibia, initial encounter for fracture
    S82.301AUnspecified fracture of lower end of right tibia, initial encounter for closed fracture
    S82.302AUnspecified fracture of lower end of left tibia, initial encounter for closed fracture
    S82.401AUnspecified fracture of shaft of right fibula, initial encounter for closed fracture
    S82.402AUnspecified fracture of shaft of left fibula, initial encounter for closed fracture

    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-29305-HIP-SPICA-BODY-CAST-TRUNK-AND-ONE-LEG

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

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

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

    Splints and cast Q-codes (supplies)
    Supplies and device billing codes associated with casting materials used during or after application of the long leg cast.