CPT 29358 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

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

CPT code 29358 represents application of a long leg brace-type cast used to immobilize and support a femur fracture while preserving knee motion via an integrated brace. Nationally, this code captures a specific orthopedic immobilization technique that balances fracture stability with early joint mobility and potential protected weight-bearing. It is relevant to hospitals, ambulatory surgery centers, emergency departments, and orthopedics practices managing lower-extremity fractures.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 29358 is used, the typical service settings, and implications for care pathways that emphasize mobilization while protecting fracture healing. The publication summarizes common billing considerations, typical sites of service, and the clinical rationale for using a hinged long leg cast for femoral shaft or distal femur fractures.

The report offers benchmarks where available, notes policy or coding updates affecting use of CPT code 29358, and highlights documentation elements important for aligning clinical indication with billing. Data not available in the input is identified explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 29358orthopedicsimmobilizationlong leg castfemur fractureambulatory surgeryhospital inpatientemergency department

Billing Code Overview

CPT code 29358 describes application of a long leg brace-type cast designed to immobilize the leg for treatment of a femur fracture. The cast incorporates a built-in brace that permits knee flexion to maintain range of motion during healing and can allow ambulation when the patient is able to bear weight on the affected leg.

Service type: Orthopedic immobilization with a hinged long leg cast/brace for femur fracture management
Typical site of service: Hospital inpatient or outpatient orthopedic procedure area, ambulatory surgery center, or emergency department for acute fracture management

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents to an orthopedic outpatient clinic after sustaining a closed midshaft femoral fracture in a motorcycle crash. The patient is hemodynamically stable, neurovascularly intact in the affected limb, and ambulatory with crutch assistance. Initial radiographs confirm a non-comminuted femoral shaft fracture requiring immobilization while planning definitive care. The provider applies a long leg brace-type cast described by 29358 to immobilize the leg while incorporating an adjustable knee brace hinge. The device permits controlled knee flexion to maintain range of motion, allows protected weight bearing as tolerated, and facilitates ambulation with assistive devices during the healing period or while awaiting surgical fixation.

Clinical workflow:

Initial evaluation in the clinic or emergency department with history, physical exam, and radiographs.
Decision to provide temporary ambulatory immobilization using a long leg brace-type cast with hinged knee component (29358) when appropriate for fracture stability and patient mobility.
Application of the brace-type cast by an orthopedic surgeon or orthopedic cast technician under provider supervision, with documentation of laterality, patient tolerance, ambulation status, and instructions for weight bearing and follow-up.
Scheduled follow-up visits for wound/skin checks, neurovascular reassessment, repeat imaging, and potential conversion to definitive fixation or continued conservative management depending on fracture healing and alignment.

Coding Specifications

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

29345-APPLICATION-OF-LONG-LEG-CAST-INCLUDES-KNEE-TO-LEG-AND-FOOT

CPT 29345: Application of Long Leg Cast Including Knee, Leg, and Foot

29355-APPLICATION-OF-LONG-LEG-CAST-THIGH-TO

CPT 29355: Application of Long Leg Cast (Thigh to Toes)

29440-APPLICATION-OF-RIGID-LEG-CAST-WALKING-OR-AMBULATORY

CPT 29440: Application of Rigid Leg Cast, Walking or Ambulatory Type

29435-LOWER-EXTREMITY-APPLICATION-OF-CAST-BELOW-KNEE-TO-HIP-LEVEL

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

29425-APPLICATION-OF-SHORT-ARM-SPLINT-FOREARM-TO-HAND

CPT 29425: Application of Static Short Arm Splint (Forearm to Hand)

29305-APPLICATION-OF-HIP-SPICA

CPT 29305: Application of Hip Spica Cast

29450-APPLICATION-OF-LONG-OR-SHORT-LEG-CLUBFOOT

CPT 29450: Application of Long or Short Leg Clubfoot Cast

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

CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

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

CPT 29325: Hip Spica / Trunk and Leg Body Cast Application

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Modifier	Description	When to Use
`LT`	Left side	When the procedure is performed on the left lower extremity.
`RT`	Right side	When the procedure is performed on the right lower extremity.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.
`25`	Significant, separately identifiable E/M service by the same physician on the same day (Note: not in provided list)	Data not available in the input.
`51`	Multiple procedures	When the brace application is billed on the same date as other procedures and payer requires a multiple-procedure modifier to denote additional procedures.
`52`	Reduced services	When application is partially reduced or not fully completed as originally described.
`53`	Discontinued procedure	When the application is started but stopped due to unforeseen circumstances.
`76`	Repeat procedure by same provider (Note: not in provided list)	Data not available in the input.
`78`	Unplanned return to the operating/procedural room by the same physician following initial procedure for a related procedure during the postoperative period	Use if an unplanned reapplication or revision is required in the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period (Note: not in provided list)	Data not available in the input.
`22`	Increased procedural services	When the application requires substantially greater work than typical (e.g., complex size, comorbidity).
`23`	Unusual anesthesia	When general anesthesia is required for the application due to patient condition.
`26`	Professional component	When billing only the professional component and a separate entity bills the technical component (rare for brace application).
`59`	Distinct procedural service	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Common specialty performing fracture immobilization and brace/cast application.
`orthotist`	Orthotics/Prosthetics Practitioner	Fitting and fabrication specialist for custom brace components; taxonomy may be `331G00000X`.
`290000000X`	Physical Medicine & Rehabilitation	Manages functional mobility, weight-bearing instructions, and rehabilitation following brace application.
`208000000X`	Family Medicine or Primary Care	May apply or manage brace application in some outpatient settings or initial emergency care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.301A`	Unspecified fracture of shaft of right femur, initial encounter for closed fracture	Common indication for application of a long leg brace-type cast with hinged knee to immobilize and allow limited ambulation.
`S72.302A`	Unspecified fracture of shaft of left femur, initial encounter for closed fracture	Left-sided equivalent for use of `29358`.
`S72.321A`	Transverse fracture of shaft of right femur, initial encounter for closed fracture	Specific fracture pattern where a knee-spanning brace may be selected for stabilization.
`S72.322A`	Transverse fracture of shaft of left femur, initial encounter for closed fracture	Left-sided transverse femoral shaft fracture indication.
`S72.001A`	Fracture of head of right femur, initial encounter for closed fracture	Proximal femur fractures may sometimes require different immobilization; included when brace use is clinically appropriate for certain proximal injuries.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29356`	Application of a short leg cast (below knee)	Alternative immobilization for distal femur or proximal tibia injuries; may be used for less extensive immobilization needs prior to or instead of `29358`.
`29515`	Application of a short leg walking cast	Used when protected weight bearing is allowed for lower leg injuries; may be selected if knee-spanning immobilization is not required.
`20690`	Preparation, mobilization, and/or manipulation of a joint under anesthesia (separate procedure)	May be performed prior to brace application if manipulation under anesthesia is required for alignment.
`29405`	Application of a body jacket; single practitioner	Used for thoracolumbar immobilization and not directly related but within bracing services spectrum for immobilization needs.
`L3908`	Orthotic device code (example L-Code) (Note: L-codes are HCPCS, not CPT)	Frequently associated with billing for brace components or custom orthotics accompanying `29358`.

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