CPT 29365 Cylinder Cast Reimbursement | OpenPayer

Summary & Overview

CPT 29365: Cylinder Cast for Leg and Knee Immobilization

CPT code 29365 represents the application of a cylinder cast that immobilizes the leg and knee for fractures of the femur, tibia, fibula, or patella. This code captures a common orthopedic immobilization procedure used in acute fracture management and post-reduction stabilization. Nationally, accurate coding for immobilization procedures affects claims processing, clinical documentation, and utilization tracking across acute and ambulatory settings.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and typical sites of service for 29365, national payer coverage considerations, and the practical billing context for fracture immobilization services. The publication outlines relevant benchmarks for utilization and coverage trends, summarizes policy and documentation expectations that commonly influence payment, and provides clinical context to align coding with fracture care pathways.

The content is intended to inform coding professionals, practice managers, and policy analysts about the role of CPT code 29365 in fracture management workflows, common billing scenarios, and areas where documentation supports appropriate payment and audit readiness.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 29365OrthopedicsFracture CareCast ApplicationImmobilizationHospital ServicesEmergency DepartmentAmbulatory SurgeryClinical Documentation

Billing Code Overview

CPT code 29365 describes application of a cylinder cast of the lower extremity that immobilizes the leg and knee for treatment of a fracture of the femur, tibia, fibula, or patella. The cylinder cast extends from the mid to upper thigh down to the bottom of the lower leg, leaving the foot and ankle free.

Service type: Application of immobilization cast for lower extremity fracture
Typical site of service: Hospital inpatient or outpatient orthopedic clinic, emergency department, ambulatory surgical center, or fracture care clinic

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 34-year-old male presents to the emergency department after a fall from a ladder with acute right mid‑shaft tibia pain, deformity, swelling, and weight‑bearing inability. Imaging confirms a closed, nondisplaced diaphyseal tibia fracture. The orthopedic provider performs a focused assessment, documents neurovascular status, provides analgesia, and applies a cylinder cast extending from mid‑thigh to the distal lower leg, leaving the foot and ankle free, to immobilize the leg and knee while awaiting definitive care or as definitive nonoperative management.

The clinical workflow includes triage and imaging in the ED or ambulatory orthopedic clinic, informed consent, neurovascular and skin assessment, measurement and trimming of stockinette and padding, molding of the cylinder cast material to obtain knee and femoral shaft immobilization, post‑application neurovascular reassessment, patient education on cast care and weight‑bearing status, and outpatient follow‑up for repeat radiographs and cast management.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when the cast is applied to the left leg or left knee.
`RT`	Right side

CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

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

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

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

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

29305-APPLICATION-OF-HIP-SPICA

CPT 29305: Application of Hip Spica Cast

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

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

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

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

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

CPT 29450: Application of Long or Short Leg Clubfoot Cast

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

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

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

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

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

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

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopedic Surgery	Primary specialty performing lower‑extremity casting and fracture management.
`207L00000X`	Sports Medicine (Orthopedics)	Orthopedic sports medicine physicians commonly apply casts for knee/leg fractures.
`208600000X`	Emergency Medicine	ED physicians frequently apply temporary immobilization casts in acute trauma.
`363A00000X`	Physical Medicine & Rehabilitation	May perform casting for immobilization in nonoperative fracture management or during rehabilitation.
`213E00000X`	Podiatry	Podiatrists may manage lower leg and ankle immobilization in certain contexts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S82.201A`	Fracture of unspecified part of right tibia, initial encounter for closed fracture	Tibial shaft fractures commonly immobilized with a long/cylinder cast involving knee and thigh.
`S72.301A`	Fracture of unspecified part of right femur, initial encounter for closed fracture	Femoral shaft or distal femur fractures may require immobilization extending to mid‑thigh.
`S82.401A`	Fracture of right fibula, initial encounter for closed fracture	Fibular fractures associated with tibial injuries may require leg and knee immobilization.
`S82.121A`	Displaced fracture of lateral condyle of right tibia, initial encounter for closed fracture	Proximal tibia/knee involvement often necessitates a cylinder cast to immobilize the knee.
`S72.305A`	Fracture of shaft of left femur, initial encounter for closed fracture	Left‑sided femoral fractures treated with cylinder casts when appropriate for nonoperative care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29515`	Application of short leg cast (below knee)	May be used when immobilization is limited to below‑knee rather than a cylinder cast extending to mid‑thigh.
`29075`	Application of splint, long leg	Alternative temporary immobilization prior to definitive cylinder cast or when swelling precludes casting.
`20690`	Application of external fixation device (unlisted trauma procedure)	Used for complex fractures requiring external fixation; may be performed before or instead of casting.
`99463`	Initial hospital or observation care (example for admission)	Administrative/clinical care codes for hospital evaluation that may accompany ED cast application.
`29580`	Application of walking cast (e.g., cast shoe)	May be used during later stages if weight‑bearing and walking cast are appropriate following initial cylinder cast.

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