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    OpenPayerBilling CodesLower Extremity Application of CastsCPT cpt-29435-walking-cast-lower-leg-tibia-fibula-fracture
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    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.

    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

    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.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 34-year-old male presents to the emergency department after a motorcycle collision with persistent pain, swelling, and deformity of the lower leg. Imaging confirms a closed mid-shaft fracture of the right tibia (S82.301A). The orthopaedic surgeon performs a closed reduction in the ED and applies a walking cast that immobilizes the lower leg and foot while allowing knee flexion to promote weight-bearing-induced mechanical stimulation of callus formation. The procedure occurs in an ambulatory surgical center or hospital outpatient department depending on associated services and patient comorbidities. Post-application workflow includes verification of cast fit and neurovascular status, patient education on weight-bearing precautions and cast care, scheduling of orthopedic follow-up for radiographic monitoring, and documentation of the procedure, laterality (use RT or LT as applicable), and diagnosis. Typical providers include orthopaedic surgeons and emergency medicine physicians with orthopedic subspecialty care coordinating follow-up.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29425Application of short leg cast (below knee to toes)Used for less extensive immobilization when fracture location and stability permit a below-knee cast instead of a walking cast

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    P2Modifier P2 denotes an ASA Physical Status II — a patient with mild systemic disease. Per AMA/AAPC, examples include well-controlled hypertension or diabetes, mild obesity (BMI 30–40), current smoker…- When to use: Append modifier -P2 to anesthesia CPT codes (00100–01999) when the anesthesia provider documents the patient has mild systemic disease (ASA Physical Status II) — for example…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    363LN0000X
    152WC0802X
    332800000X
    261QS0112X
    2084N0400X
    364SP0812X
    2083T0002X
    207QA0505X

    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-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-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 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.

    29440Lower extremity application of casts (complex or walking boot variant)Used for more complex cast applications or special walking boot-type immobilizers; may be an alternative or adjunct depending on fracture complexity