Surgical · Spine

Application of a rigid body cast extending from the shoulder girdle down to the hip region to immobilize the trunk and spine.

Verified May 8, 2026 · 7 sources ↓

Medicare: $299.94
Work RVU: 1.73
Global, days: 0
Region: Spine

Drawn from CMSEmednyFastrvuBedrockbilling

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Clinical indication requiring body cast immobilization (e.g., spinal deformity, vertebral fracture, post-op stabilization) with specific diagnosis
Documentation that a cast — not a brace or splint — was medically necessary and applied
Extent of cast: confirm it spans shoulder to hip level; note materials used (plaster vs. fiberglass)
If applied post-operatively, document that the cast application is separate from and not included in the surgical package global period
Provider name, date of service, and direct supervision or performance notation for facility-based applications
For cast replacement: document specific clinical reason (soiling, structural failure, clinical change) that necessitated a new application

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 52 Reduced services 59 Distinct service 76 Repeat, same physician 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29035 describes the application of a body cast spanning from the shoulders to the hips. It is used to immobilize the thoracic and lumbar spine — most commonly after surgical correction of congenital spinal deformity, post-traumatic spinal injury management, or when rigid external immobilization is required and a brace is insufficient. The cast encompasses the full trunk and is typically plaster or fiberglass-based, molded directly to the patient.

This code carries a 0-day global period, meaning the cast application itself is the billable event — no bundled pre- or post-op care is assumed. A same-day E/M for a separately identifiable problem requires modifier 25. If the same physician who performed the spine surgery applies the cast during the same encounter, the cast application may be separately reportable depending on payer policy; document medical necessity for the cast as distinct from routine surgical dressing or immobilization included in the surgical package.

Billing 29035 in the facility setting versus the office setting affects payment significantly — see the Site of Service comparison. The code is billed once per application episode; if the cast must be replaced due to soiling, breakdown, or clinical change, a new application is separately billable with documentation of the reason for replacement.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.73
Practice expense RVU	6.88
Malpractice RVU	0.37
Total RVU	8.98
Medicare national rate	$299.94
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$299.94
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P2) Ambulatory surgical center (freestanding)	$153.62

Common denial reasons

The recurring reasons claims for CPT 29035 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Bundled into a same-day spine surgery global package without documentation that the cast application is a distinct, separately payable service
Missing or vague diagnosis linkage — payer cannot confirm the cast is medically necessary for the billed ICD-10 code
E/M billed same-day without modifier 25, triggering automatic bundling denial
Incorrect site-of-service code causing payment mismatch between facility and non-facility rates
Duplicate billing when cast replacement is submitted without documentation of why the original cast required replacement

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can 29035 be billed the same day as a spine surgery?

Potentially yes, but it depends on whether the cast application is considered part of the surgical package. Document that the body cast goes beyond routine intraoperative immobilization and is separately medically necessary. Some payers bundle it; others pay separately with modifier 59. Verify with the specific payer before submitting.

02What modifier is needed if an E/M is billed the same day as 29035?

Modifier 25 on the E/M code. The E/M must be for a separately identifiable problem or decision beyond the cast application itself. Without modifier 25, the E/M will be denied as bundled.

03Is 29035 the right code if the cast extends down one or both thighs?

No. If the cast includes one thigh, use 29044. If it includes both thighs, use 29046. Use 29035 only when the cast terminates at the hip level without incorporating the thighs.

04Does the 0-day global on 29035 mean post-op visits are separately billable?

Yes. A 0-day global covers only the day of the procedure. Any follow-up visits the next day or later are separately billable — no modifier needed unless a payer specifically requires one.

05If the cast breaks down and must be reapplied, is a second 29035 billable?

Yes. A cast replacement is a new application and is separately billable. Document the clinical reason for replacement — structural failure, soiling, or a change in clinical status. Without that documentation, a second same-period claim will be flagged as a duplicate.

06Does 29035 require imaging guidance to be billed separately?

Not typically. Cast application is a manual procedure. If fluoroscopic guidance was used to confirm alignment before casting, that imaging may be separately billable with appropriate documentation, but it is not a routine component of 29035.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the clinical indication (diagnosis, mechanism, or post-op status), cast material and extent (shoulder to hip), and whether the application was performed at the time of surgery or as a standalone encounter. That detail prevents the two most common denials: bundling into an operative global and medical-necessity rejection from a vague or mismatched diagnosis.

See how Mira captures CPT 29035 documentation