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CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

CPT code 29445 denotes the application of a short leg total contact walking cast (TCC) used to offload and treat diabetic foot ulcers. This code captures a specialized, device-based therapeutic procedure that enables patients to ambulate while protecting and distributing pressure away from ulcerated areas. Nationally, the procedure is an important tool in diabetic wound management because it can reduce healing time, prevent complications, and lower the risk of lower-extremity amputation when used appropriately.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the use of a TCC, common settings where the service is delivered, and an overview of what to expect in payer coverage discussions. The publication outlines benchmark considerations, typical utilization patterns, and relevant policy updates affecting reimbursement and billing practice.

This summary also highlights operational and coding implications for providers and billing staff, including documentation focal points and common modifier considerations. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 29445 describes the application of a short leg total contact walking cast (TCC) that covers the lower leg, ankle, and foot to treat diabetic foot ulcers. The cast is formed to fit a removable cast shoe that straps on or is embedded with a footplate and rubber heel to permit walking.

Service type: Therapeutic casting for offloading diabetic foot wounds

Typical site of service: Outpatient clinic, wound care center, or ambulatory surgical/orthopedic clinic

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CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

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Get alerted when payer policies referencing 29445 are released or updated.

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Billing Code Overview

Service type: Therapeutic casting for offloading diabetic foot wounds

Typical site of service: Outpatient clinic, wound care center, or ambulatory surgical/orthopedic clinic

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with diabetes mellitus who presents to a podiatry or wound-care clinic for management of a non-healing plantar foot ulcer. The provider evaluates perfusion, infection signs, and offloading needs. After debridement and wound assessment, the clinician selects a total contact cast (TCC) to provide definitive offloading of the lower leg, ankle, and foot. The procedure is performed in an outpatient clinic, ambulatory surgery center, or hospital-based wound clinic. The TCC is molded to the patient’s limb and fitted to accept a removable cast shoe or is formed with an embedded footplate and rubber heel to permit protected weight-bearing. Typical workflow: history and focused exam, wound measurement and dressing change, debridement as needed, cast application (material selection, molding, padding), patient education on cast care and activity restrictions, and scheduling follow-up for cast change and wound reassessment. This procedure is billed using 29445 for application of a short leg walking or total contact cast for diabetic ulcer offloading.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service on the same day	Use when a distinct evaluation and management visit is provided on the same day as `29445` and meets documentation requirements.
`52`	Reduced services	Use if the cast application is partially reduced from full procedure components (rare).
`59`	Distinct procedural service	Use when another procedure on the same day is unrelated and distinct from `29445` (document distinction).
`62`	Two surgeons	Use when two surgeons of different specialties share responsibility for the cast application.
`76`	Repeat procedure by same physician	Use when `29445` is reapplied by the same provider during the same operative day (if applicable).
`77`	Repeat procedure by another physician	Use when another provider reapplies the TCC the same day and documents reason.
`78`	Unplanned return to the operating/procedure room	Use if the patient requires an unplanned return for cast revision under the same encounter.
`79`	Unrelated procedure/service by the same physician during the postoperative period	Use if an unrelated service is performed during global period.
`LT`	Left side	Use to indicate the left lower extremity.
`RT`	Right side	Use to indicate the right lower extremity.
`TC`	Technical component	Use when billing only the technical component (facility or device) separate from professional component.
`26`	Professional component	Use when billing only the professional component separate from the technical component.
`KX`	Requirements specified in the medical policy are met	Use when payer-specific medical necessity criteria for TCC are satisfied and documentation supports KX.
`GA`	Waiver of liability statement on file (Note: not in supplied list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207N00000X`	Podiatry	Podiatrists commonly apply TCCs for diabetic foot ulcers.
`207L00000X`	Orthopedic Surgery	Orthopedic foot and ankle surgeons apply TCCs in limb salvage protocols.
`2080P0006X`	Family Medicine	Family medicine clinicians in wound centers may apply TCCs with appropriate training.
`208D00000X`	Physical Medicine & Rehabilitation	PM&R specialists participate in offloading and mobility management.
`363L00000X`	Wound Care Specialist	Clinicians specializing in wound care manage casting and wound assessments.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes with foot ulcer is a primary indication for use of a TCC for offloading and wound healing.
`E10.621`	Type 1 diabetes mellitus with foot ulcer	Type 1 diabetes patients with plantar ulcers may require TCC offloading.
`L97.429`	Non-pressure chronic ulcer of left lower leg with unspecified severity	Chronic lower extremity ulcers may be managed with offloading via TCC when located on the foot/ankle.
`L97.419`	Non-pressure chronic ulcer of right lower leg with unspecified severity	Similar relevance for right-sided ulcers requiring immobilization/offloading.
`M86.672`	Other osteomyelitis, left lower leg	When bone infection is present, TCCs may be used as part of limb-salvage protocols while treating infection.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; subcutaneous tissue (first 20 sq cm or less)	Sharp debridement of wound bed commonly performed immediately prior to applying a TCC.
`97597`	Debridement (eg, high-pressure water jet, sharp) & wound debridement, selective debridement, initial; first 20 sq cm	Used for wound debridement and preparation before offloading with a TCC.
`29580`	Application of short leg splint (calf to foot)	Alternative temporary immobilization before definitive `29445` TCC application or between cast changes.
`29540`	Strapping; ankle and/or foot	Adjunctive stabilization or when full TCC is not indicated.
`11044`	Debridement; muscle and/or fascia, first 20 sq cm	More extensive debridement that may precede TCC application in complex ulcers.

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

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

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

CPT-29345-LONG-LEG-CAST-APPLICATION-IMMOBILIZATION

CPT 29345: Long Leg Cast Application, Leg and Knee 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 for Femur Fracture

CPT-29365-CYLINDER-CAST-LEG-KNEE-IMMOBILIZATION-FRACTURE

CPT 29365: Cylinder Cast for Leg and Knee 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 for Tibia/Fibula Fracture or Severe Ankle Sprain

CPT-29435-WALKING-CAST-LOWER-LEG-TIBIA-FIBULA-FRACTURE

CPT 29435: Walking Cast for Tibia and Fibula Shaft Fractures

CPT-29440-REMOVABLE-WALKER-OR-HEEL-PAD-FOR-LEG-CAST

CPT 29440: Addition of Removable Walker or Heel Pad to Leg Cast

Showing 1–10 of 11

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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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.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service on the same day	Use when a distinct evaluation and management visit is provided on the same day as `29445` and meets documentation requirements.
`52`	Reduced services	Use if the cast application is partially reduced from full procedure components (rare).
`59`	Distinct procedural service	Use when another procedure on the same day is unrelated and distinct from `29445` (document distinction).
`62`	Two surgeons	Use when two surgeons of different specialties share responsibility for the cast application.
`76`	Repeat procedure by same physician	Use when `29445` is reapplied by the same provider during the same operative day (if applicable).
`77`	Repeat procedure by another physician	Use when another provider reapplies the TCC the same day and documents reason.
`78`	Unplanned return to the operating/procedure room	Use if the patient requires an unplanned return for cast revision under the same encounter.
`79`	Unrelated procedure/service by the same physician during the postoperative period	Use if an unrelated service is performed during global period.
`LT`	Left side	Use to indicate the left lower extremity.
`RT`	Right side	Use to indicate the right lower extremity.
`TC`	Technical component	Use when billing only the technical component (facility or device) separate from professional component.
`26`	Professional component	Use when billing only the professional component separate from the technical component.
`KX`	Requirements specified in the medical policy are met	Use when payer-specific medical necessity criteria for TCC are satisfied and documentation supports KX.
`GA`	Waiver of liability statement on file (Note: not in supplied list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207N00000X`	Podiatry	Podiatrists commonly apply TCCs for diabetic foot ulcers.
`207L00000X`	Orthopedic Surgery	Orthopedic foot and ankle surgeons apply TCCs in limb salvage protocols.
`2080P0006X`	Family Medicine	Family medicine clinicians in wound centers may apply TCCs with appropriate training.
`208D00000X`	Physical Medicine & Rehabilitation	PM&R specialists participate in offloading and mobility management.
`363L00000X`	Wound Care Specialist	Clinicians specializing in wound care manage casting and wound assessments.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes with foot ulcer is a primary indication for use of a TCC for offloading and wound healing.
`E10.621`	Type 1 diabetes mellitus with foot ulcer	Type 1 diabetes patients with plantar ulcers may require TCC offloading.
`L97.429`	Non-pressure chronic ulcer of left lower leg with unspecified severity	Chronic lower extremity ulcers may be managed with offloading via TCC when located on the foot/ankle.
`L97.419`	Non-pressure chronic ulcer of right lower leg with unspecified severity	Similar relevance for right-sided ulcers requiring immobilization/offloading.
`M86.672`	Other osteomyelitis, left lower leg	When bone infection is present, TCCs may be used as part of limb-salvage protocols while treating infection.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; subcutaneous tissue (first 20 sq cm or less)	Sharp debridement of wound bed commonly performed immediately prior to applying a TCC.
`97597`	Debridement (eg, high-pressure water jet, sharp) & wound debridement, selective debridement, initial; first 20 sq cm	Used for wound debridement and preparation before offloading with a TCC.
`29580`	Application of short leg splint (calf to foot)	Alternative temporary immobilization before definitive `29445` TCC application or between cast changes.
`29540`	Strapping; ankle and/or foot	Adjunctive stabilization or when full TCC is not indicated.
`11044`	Debridement; muscle and/or fascia, first 20 sq cm	More extensive debridement that may precede TCC application in complex ulcers.

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

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

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

CPT-29345-LONG-LEG-CAST-APPLICATION-IMMOBILIZATION

CPT 29345: Long Leg Cast Application, Leg and Knee 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 for Femur Fracture

CPT-29365-CYLINDER-CAST-LEG-KNEE-IMMOBILIZATION-FRACTURE

CPT 29365: Cylinder Cast for Leg and Knee 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 for Tibia/Fibula Fracture or Severe Ankle Sprain

CPT-29435-WALKING-CAST-LOWER-LEG-TIBIA-FIBULA-FRACTURE

CPT 29435: Walking Cast for Tibia and Fibula Shaft Fractures

CPT-29440-REMOVABLE-WALKER-OR-HEEL-PAD-FOR-LEG-CAST

CPT 29440: Addition of Removable Walker or Heel Pad to Leg Cast

Showing 1–10 of 11

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

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Billing Code Overview

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CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

Sign up for cpt 29445 policy alerts

Billing Code Overview

CPT 29445: Total Contact Walking Cast for Diabetic Foot Ulcer

Sign up for cpt 29445 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 29445 represent and where is the service commonly performed?

Which modifiers are commonly relevant when billing CPT 29445?

What related CPT codes should I consider when a TCC is applied?

What ICD-10 diagnoses support medical necessity for CPT 29445?

What documentation elements are important when billing for CPT 29445?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 29445 represent and where is the service commonly performed?

Which modifiers are commonly relevant when billing CPT 29445?

What related CPT codes should I consider when a TCC is applied?

What ICD-10 diagnoses support medical necessity for CPT 29445?

What documentation elements are important when billing for CPT 29445?

References