CPT 29435: Lower Leg Walking Cast for Tibia/Fibula Shaft Fracture
Medicare pays $144 and commercial payers pay $305 on average nationally for this procedure.
CPT code 29435 describes application of a specialized lower leg and foot cast that immobilizes the tibia and fibula shaft fracture while allowing knee flexion; this service is a cast application procedure used to provide controlled weight-bearing pressure at the fracture site to stimulate bone healing, typically performed in an outpatient orthopedic clinic or emergency/ambulatory surgical setting as part of fracture management and immobilization care.
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National Reimbursement Benchmarks
Medicare’s mean rate of $143.7 sits well below BUCA’s average commercial mean of $305.2, indicating a substantial gap between federal reimbursement and this commercial benchmark for CPT 29435. This gap reflects a common pattern where large commercial networks pay materially more than Medicare; here the difference is $161.5 in mean rates, with BUCA roughly double Medicare on average.
Dispersion analysis (P75 minus P25) highlights variability across payers: Blue Cross Blue Shield has the widest interquartile spread at $162.5 ($520.6 - $348.1), followed by BUCA at $136.2 ($376.2 - $236.0). UnitedHealth Group and Cigna show intermediate spreads of $107.4 ($225.2 - $114.8) and $110.1 ($222.5 - $114.4) respectively, while Aetna is the tightest at $73.4 ($103.4 - $30.0). Medicare’s P75–P25 is $16 ($150 - $134), indicating the least variation among listed payers.