Application of a figure-of-eight cast to immobilize the upper extremity or shoulder girdle region.

Verified May 8, 2026 · 5 sources ↓

Medicare: $113.90
Work RVU: 0.87
Global, days: 0
Region: Shoulder

Drawn from CMSBedrockbillingCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis with fracture site, laterality, and displacement status (e.g., midshaft clavicle fracture, left, minimally displaced)
Explicit notation that a figure-of-eight cast — not a sling, splint, or wrap — was applied
Clinical justification for immobilization technique chosen over alternatives
Patient instructions given and follow-up plan documented
Provider identity, date of service, and place of service

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 50 Bilateral procedure 52 Reduced services 59 Distinct service LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 29049 covers the application of a figure-of-eight cast, in which cast material is wrapped so that one turn crosses the other at the midpoint, creating a configuration resembling the numeral 8. The technique is used to immobilize clavicle fractures and certain shoulder girdle injuries by retracting the shoulders and maintaining reduction through the crossing tension of the cast. It is distinct from a shoulder spica (29055) or Velpeau (29058) and should not be reported interchangeably with those codes.

The global period is 000, meaning there is no post-op global window — office visits on subsequent days bill separately. Because casting codes in this family are often applied in the ED or urgent care setting as well as in the office, site-of-service matters: facility vs. non-facility rates differ, and the HOPD and ASC payment rates diverge sharply from the physician fee schedule. Confirm which setting is driving the claim before submitting.

NCCI edits place 36430 (blood transfusion) as a column 2 code bundled under 29049 with modifier indicator 1, meaning a modifier can permit separate reporting when truly distinct. That pairing is rarely relevant clinically but surfaces in multi-procedure trauma encounters. Check the NCCI PTP lookup before bundling any E/M or supply codes on the same date.

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 (0.87) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.87
Practice expense RVU	2.35
Malpractice RVU	0.19
Total RVU	3.41
Medicare national rate	$113.90
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	$113.90
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$78.88

Common denial reasons

The recurring reasons claims for CPT 29049 get rejected.

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

Cast application billed same-day as an E/M without modifier 25 on the E/M — the visit gets bundled
Incorrect site-of-service code causing payment at the wrong fee schedule rate
Diagnosis code does not support casting (e.g., soft-tissue contusion only, no fracture or instability documented)
Code submitted as bilateral without clinical documentation supporting bilateral application

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill an E/M on the same day as 29049?

Yes — append modifier 25 to the E/M to show it was a separately identifiable service beyond the decision to apply the cast. Without modifier 25, the E/M will be bundled into the casting code.

02What is the global period for 29049?

Zero days (000). There is no post-op global window, so all follow-up visits after the date of service bill separately using the appropriate E/M code.

03How does 29049 differ from 29055 or 29058?

29049 is specifically the figure-of-eight configuration. 29055 is a shoulder spica and 29058 is a plaster Velpeau. These are not interchangeable — use the code that matches the cast actually applied and documented in the operative or clinic note.

04Is 29049 billable in the emergency department?

Yes, but site-of-service drives payment. The HOPD rate differs from the non-facility physician fee schedule rate. Confirm the place-of-service code on the claim matches where the cast was applied.

05Can 29049 be billed bilaterally?

Bilateral application is clinically rare for a figure-of-eight cast, but if performed, append modifier 50 and document the clinical rationale for bilateral immobilization in the note.

06What NCCI bundling issue should I watch for with 29049?

CPT 36430 (blood transfusion) is bundled under 29049 as a column 2 code with modifier indicator 1. In multi-procedure trauma encounters, use a modifier and document distinct clinical necessity if both are reported on the same date.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the cast type by name (figure-of-eight), the anatomic site and laterality, the clinical indication (fracture site, displacement status), and whether the cast was applied in the context of a separately identifiable E/M visit. That documentation prevents the two most common denials: upcoding to a wrong cast code due to a generic 'cast applied' dictation, and E/M bundling denials when modifier 25 is warranted.

See how Mira captures CPT 29049 documentation