Application of a plaster Velpeau cast immobilizing the shoulder, arm, and flexed forearm against the trunk.

Verified May 8, 2026 · 5 sources ↓

Medicare: $138.28
Work RVU: 1.28
Global, days: 0
Region: Shoulder

Drawn from CMSNIHAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving the cast application (fracture site, dislocation type, or post-reduction stabilization need)
Named injury or condition: humerus fracture, clavicle fracture, scapula fracture, or specific joint dislocation reduced
Laterality of the extremity immobilized (left or right)
Clinical justification for Velpeau technique over a simpler sling or splint
Cast material documented as plaster (not fiberglass — separate code set applies)
Provider who applied the cast and date of service

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 52 Reduced services 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 29058 covers application of a plaster Velpeau cast — a body and upper extremity cast that holds the flexed forearm against the patient's trunk, eliminating motion at the shoulder, elbow, and adjacent joints. It is used for fractures of the humerus, scapula, or clavicle, and after reduction of glenohumeral, sternoclavicular, or acromioclavicular joint dislocations.

The global period is 000, meaning normal post-op care is not bundled — but that also means the E/M on the day of casting requires modifier 25 to be separately billable if a significant, separately identifiable service was provided. If the cast is applied in a facility setting, the HOPD and ASC payment differentials are substantial; see the Site of Service comparison table.

Do not report 29058 with a same-day E/M unless modifier 25 is appended and documented. Fracture care codes include casting in their work value, so billing 29058 alongside a fracture care code for the same injury creates an NCCI bundling problem — verify the PTP edit status before stacking these codes.

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 (1.28) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.14) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.28
Practice expense RVU	2.6
Malpractice RVU	0.26
Total RVU	4.14
Medicare national rate	$138.28
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	$138.28
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$87.28

Common denial reasons

The recurring reasons claims for CPT 29058 get rejected.

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

E/M billed same-day without modifier 25, triggering a bundling denial
29058 billed alongside a fracture care code for the same injury — casting is included in fracture care RVUs
Laterality not documented, causing claim to reject or pend for medical records
Fiberglass cast applied but plaster cast code billed — material mismatch on audit
Missing or vague diagnosis code that does not support upper extremity immobilization at the shoulder

Frequently asked questions

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

01Can I bill 29058 and a fracture care code on the same date for the same injury?

No. Fracture care codes include the initial casting in their work value. Billing 29058 alongside the fracture care code for the same injury is an NCCI bundling issue. 29058 is appropriate when casting is the only service rendered — for example, when another provider performed the fracture reduction.

02Does the 000 global period mean I can bill an E/M the same day as the cast application?

Yes, but modifier 25 is required on the E/M. The 000 global does not automatically allow same-day E/M billing — you still need to show the E/M was a significant, separately identifiable service unrelated to or beyond the decision to apply the cast.

03What is the difference between 29058 and a fiberglass shoulder cast code?

29058 is specific to plaster. Fiberglass Velpeau-type casting uses a different code. Payers audit cast material, and billing plaster codes when fiberglass was used — or vice versa — is a documentation mismatch that can trigger overpayment recovery.

04Is 29058 bilateral? Can I append modifier 50?

A Velpeau cast immobilizes one shoulder and upper extremity by definition. Bilateral application is not clinically applicable, so modifier 50 is not appropriate for this code.

05Why is the ASC payment so much lower than the HOPD payment for 29058?

CMS assigns casting codes a lower ASC payment because the procedure is considered appropriate for office and outpatient settings where overhead costs are lower. If you're performing this in a hospital outpatient department, the HOPD rate applies. See the Site of Service comparison table on this page for the current figures.

06Can a non-physician (PA, NP, or cast technician) bill 29058?

A PA or NP billing under their own NPI can report 29058 within their scope. A cast technician performing application under physician supervision typically bills incident-to under the supervising physician's NPI. Payer rules on incident-to supervision levels vary — commercial payers may differ from Medicare policy.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the injury type (fracture vs. dislocation), the specific bone or joint involved, laterality, and the cast material (plaster) from the provider's dictation. This prevents the two most common denials for 29058: a missing or mismatched diagnosis code and a material mismatch when fiberglass is inadvertently coded instead of plaster.

See how Mira captures CPT 29058 documentation