Application of a shoulder spica cast, encompassing the trunk and upper extremity to immobilize the glenohumeral joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $258.19
Work RVU: 1.74
Global, days: 0
Region: Shoulder

Drawn from CMSBedrockbillingAAOSCgsmedicare

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 laterality — specify left or right shoulder and the underlying condition requiring spica immobilization
Clinical justification for spica-level immobilization rather than a simpler device (sling, splint, or clavicle strap)
Description of cast materials used, position of the arm at time of application, and extent of coverage (trunk to forearm/hand)
If billed same-day with an E/M, document that the evaluation was significant and separately identifiable from pre-service cast application work
Neurovascular status of the extremity documented before and after cast application
Supervising or performing provider identity and, if applicable, resident or mid-level involvement

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 29055 covers the application of a shoulder spica cast — a rigid immobilization device that encases the trunk and the affected arm, holding the shoulder in a fixed position. It is used when standard sling or splint immobilization is insufficient, such as after certain humeral fracture reductions, post-surgical stabilization requirements, or in pediatric cases demanding strict glenohumeral immobilization. The cast typically incorporates the thorax and extends down the arm, distinguishing it from simpler shoulder immobilizers billed under other codes.

The global period is 000, meaning follow-up E/M visits on subsequent days are separately billable. Any E/M service billed on the same day as cast application requires modifier 25 to demonstrate it was a significant, separately identifiable service beyond the pre-service work inherent to the cast application itself. If the same surgeon later removes and reapplies the cast under a different encounter, that service bills separately. Laterality modifiers LT and RT are appropriate and expected — claims submitted without them for a unilateral procedure draw payer scrutiny.

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 (1.74) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.73) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.74
Practice expense RVU	5.62
Malpractice RVU	0.37
Total RVU	7.73
Medicare national rate	$258.19
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	$258.19
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 29055 get rejected.

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

Missing laterality modifier — payers reject or suspend unilateral cast claims submitted without LT or RT
Same-day E/M denied when modifier 25 is absent, because the E/M is presumed bundled into the 000-global procedure
Medical necessity denial when documentation does not justify spica immobilization over a lesser device
Bundling denial when a fracture care or surgical procedure code on the same claim includes casting as an inherent component
Incorrect site-of-service code causing payment at wrong rate, particularly when cast is applied in a facility setting

Frequently asked questions

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

01Does the 000-day global on 29055 mean I can bill a follow-up visit the next day without a modifier?

Yes. A 000-day global covers only the day of the procedure. E/M visits on any subsequent day bill normally without a global-period modifier.

02Can I bill 29055 and an E/M on the same date of service?

Yes, but you must append modifier 25 to the E/M code. The E/M note must document a significant and separately identifiable service beyond the pre-service evaluation inherent to applying the cast.

03Which laterality modifier is required — LT, RT, or 50?

Use LT or RT for a unilateral shoulder spica. Modifier 50 is reserved for bilateral procedures performed at the same session, which would be anatomically unusual for a spica cast.

04Is cast removal separately billable when the same physician removes a spica applied under 29055?

Cast removal by the same physician who applied the cast is generally not separately billable. Removal by a different provider can be reported with the appropriate cast removal code.

05When would modifier 22 apply to 29055?

Modifier 22 is appropriate when the application is substantially more complex than typical — for example, accommodating a severe deformity, extensive soft tissue injury, or unusual positioning requirement. Document the additional time and complexity explicitly in the operative or procedure note.

06If a fracture is reduced and the spica is applied in the same encounter, can both be billed?

Fracture care codes often include casting as part of the global service. Check NCCI bundling edits for the specific fracture care code before billing 29055 separately; in many pairings, the cast application is bundled into the fracture care code.

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 for spica-level immobilization, arm position at application, cast materials, extent of coverage from trunk to distal extremity, and pre/post neurovascular exam findings. That documentation prevents the two most common denials: medical necessity rejections that cite insufficient justification for spica versus a simpler device, and same-day E/M bundling denials that stem from notes that fail to distinguish the evaluation from the procedure's inherent pre-service work.

See how Mira captures CPT 29055 documentation