Application of a long arm cast extending from the shoulder to the hand, used to immobilize fractures or injuries involving the forearm, elbow, or humerus.

Verified May 8, 2026 · 7 sources ↓

Medicare: $108.22
Work RVU: 0.85
Global, days: 0
Region: Shoulder

Drawn from CMSAAPCMdclarityEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify anatomical extent of cast — confirm it runs from shoulder to hand (long arm, not short arm)
Document the clinical indication: fracture location, deformity, or injury requiring long arm immobilization
Record the cast material used (plaster vs. fiberglass) to support the correct Q-code supply billing (Q4005–Q4008)
If an E/M is billed same-day, document the separately identifiable service to justify modifier 25
Note laterality (left or right arm) to support LT/RT modifier selection
Document neurovascular status before and after cast 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 50 Bilateral procedure 51 Multiple procedures 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 7 cited references ↓

CPT 29065 covers the application of a long arm cast running from the shoulder to the hand — encasing both the upper and lower arm. It's used for fractures of the humerus, elbow, or forearm, and for correcting deformities requiring full upper-extremity immobilization. The cast material (plaster or fiberglass) is reported separately using supply codes Q4005 through Q4008, per CMS crosswalk guidance.

The code carries a 0-day global period, meaning E/M services on the same date are separately billable — but only if a separately identifiable, documented service exists. Append modifier 25 to the E/M when billing both on the same day. If the same physician applies a new cast during the follow-up period for fracture care, modifier 58 applies.

Critical bundling rule: 29065 bundles into most fracture care codes under NCCI edits. When a fracture care procedure (e.g., 24342) is billed, do not separately bill 29065 — the cast application is included. Report 29065 only when no fracture care code is billed on the same encounter, or when the cast is applied for a distinctly different condition with appropriate modifier support.

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 (0.85) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.24) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.85
Practice expense RVU	2.22
Malpractice RVU	0.17
Total RVU	3.24
Medicare national rate	$108.22
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	$108.22
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$74.52

Common denial reasons

The recurring reasons claims for CPT 29065 get rejected.

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

Bundled into same-day fracture care code (e.g., 24342) — NCCI edits prohibit separate billing of 29065 when fracture care is reported
Missing modifier 25 on same-day E/M, causing the office visit to deny as included in the cast application
Incorrect or missing Q-code for cast supplies — payers expect Q4005–Q4008 billed alongside 29065
Laterality modifier absent — some payers require LT or RT on all unilateral upper-extremity procedures
Cast application billed separately during a fracture care global period without modifier 58 for planned cast change

Frequently asked questions

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

01Can I bill 29065 and a fracture care code on the same day?

No. NCCI edits bundle 29065 into most fracture care codes, including shoulder and elbow fracture/dislocation codes. Bill the fracture care code only; the cast application is included. Report supply codes Q4005–Q4008 separately for cast materials.

02What supply codes go with 29065?

Per the CMS Billing and Coding: Fracture Care article (A52767), the applicable Level II supply codes for 29065 are Q4005 through Q4008. Select the specific Q code based on cast type and material.

03Can I bill an office visit the same day as 29065?

Yes, if a separately identifiable E/M service was performed. Append modifier 25 to the E/M and document the distinct clinical decision-making. The 0-day global period on 29065 does not block same-day E/M billing — but the documentation must hold up to audit.

04If I need to change the cast during the follow-up period, what modifier applies?

Modifier 58 — planned or staged procedure during the global period. Cast changes by the same physician treating the same condition are staged services, not new procedures. Modifier 58 allows separate billing for the subsequent cast application.

05When would modifier 22 apply to 29065?

Rarely, but it applies when the cast application is significantly more complex than usual — for example, severe swelling, complex positioning requirements, or a patient with unusual anatomy that substantially increases time and effort. Documentation must clearly explain why the service exceeded typical complexity.

06Does 29065 require laterality modifiers?

Best practice is yes. Append LT or RT to identify which arm received the cast. Some payers require it for processing; omitting laterality is a common clean-claim failure point for unilateral upper-extremity procedures.

07What is the difference between 29065 and 29075?

29065 is a long arm cast — shoulder to hand. 29075 is a short arm cast — below the elbow to the hand. Upcoding from 29075 to 29065 is an audit risk; the operative note must confirm the cast extended to the shoulder.

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 (long arm, shoulder to hand), material (plaster or fiberglass), laterality, clinical indication, and post-application neurovascular check directly from dictation. This ensures the operative or procedure note explicitly supports the long arm designation — preventing downcoding to 29075 (short arm) — and flags the correct Q-code range (Q4005–Q4008) for supply billing at charge entry.

See how Mira captures CPT 29065 documentation