Application of a Minerva-type body cast extending from the trunk through the shoulders and up to include the head and neck (cervicothoracic immobilization).
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $339.35
- Total RVUs
- 10.16
- Global, days
- 0
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Explicit confirmation that the cast extends to include the head, jaw, and occiput — not just the trunk and shoulders
- Diagnosis documented by name (e.g., cervical fracture, torticollis, thoracic spine injury, scoliosis) with corresponding ICD-10 code
- Cast material type specified (plaster vs. fiberglass) and indication for Minerva-type versus alternative immobilization
- Clinical rationale for Minerva cast versus less restrictive immobilization (halo, TLSO, cervical orthosis)
- Patient positioning during application and any sedation or assistance required, particularly for pediatric cases
- Pre- and post-application neurological status documented when applied for spinal injury
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 29040 covers application of a Minerva body cast — a full-torso cast that incorporates the shoulders, extends up the neck, and encases the jaw and head to achieve rigid cervicothoracic immobilization. It is used for cervical or thoracic spine fractures, severe torticollis, and select scoliosis cases where a halo or brace is insufficient or contraindicated.
This is one of the most extensive cast applications in the CPT cast family. The cast must encircle the trunk from the hips, incorporate both shoulder girdles, and extend superiorly to include the occiput and mandible. Distinguishing 29040 from 29035 (body cast, shoulder to hips, no head) is a common documentation failure — the operative/procedure note must explicitly confirm cephalic extension to the head and neck.
The global period is 000, meaning cast application does not carry any post-procedure global days. Same-day E/M services require modifier 25 on the E/M. If the cast is applied as part of a fracture care package billed under a separate surgical code, the cast application is bundled — do not bill 29040 separately unless the cast application is the standalone procedure without associated fracture care.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 2.16 |
| Practice expense RVU | 7.55 |
| Malpractice RVU | 0.45 |
| Total RVU | 10.16 |
| Medicare national rate | $339.35 |
| 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 | $339.35 |
HOPD (APC 5102) Hospital outpatient department | $285.75 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $153.62 |
Common denial reasons
The recurring reasons claims for CPT 29040 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundling denial when billed alongside a fracture care code that already includes cast application
- Missing documentation of cephalic extension — payer downcodes to 29035 (shoulder to hips only) when notes don't confirm head/neck inclusion
- Diagnosis-to-procedure mismatch — ICD-10 code for a lower-extremity or non-cervicothoracic condition paired with 29040
- No modifier 25 on a same-day E/M service, triggering automatic edit and denial of the E/M
- Lack of medical necessity documentation when applied for scoliosis without supporting imaging or prior conservative treatment record
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What separates CPT 29040 from 29035?
02Can I bill 29040 separately when it's applied after a spine fracture repair?
03Is modifier 50 appropriate for 29040?
04What is the global period for 29040, and does it affect same-day E/M billing?
05Which ICD-10 codes typically pair with 29040?
06Does 29040 require prior authorization?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the cast type by name (Minerva), the anatomical extent (trunk, bilateral shoulders, neck, jaw, occiput), the indication (e.g., C-spine fracture, torticollis), cast material, and the treating provider. It flags notes where cephalic extension isn't explicitly stated — the single most common reason 29040 is downgraded to 29035 on audit. If an E/M is documented the same day, the scribe tags it for modifier 25.
See how Mira captures CPT 29040 documentation