Application of a gauntlet cast encasing the hand and lower forearm, used to immobilize wrist and hand injuries or post-surgical sites.

Verified May 8, 2026 · 5 sources ↓

Medicare: $106.88
Total RVUs: 3.2
Global, days: 0
Region: Hand

Drawn from CMSAAPCAshtAshlink

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 immobilization (fracture type, dislocation, post-op stabilization) with ICD-10 code linked to clinical findings
Laterality documented — right, left, or bilateral — matching the modifier appended on the claim
Cast type specified as gauntlet (hand and lower forearm); notes that say only 'cast applied' are an audit flag
Reason for recasting if applied during another procedure's global period, supporting medical necessity for modifier 58
Confirmation that casting is not bundled into a same-day musculoskeletal procedure performed on the same anatomic area
If E/M billed same-day, documentation must support a separately identifiable decision-making service beyond cast selection

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 KX Documentation on file AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 29085 covers the application of a gauntlet-style cast — a rigid circumferential dressing that extends from the palm through the lower forearm, typically including the thumb. It is the go-to immobilization code for metacarpal fractures, distal radius injuries not requiring manipulation, scaphoid fractures, and post-operative stabilization of wrist and hand procedures. The gauntlet configuration distinguishes it from a short arm cast (29075) by its extension over the hand and thumb web space.

NCCI bundles 29085 into most same-day fracture care codes. If you applied the cast as part of initial fracture treatment, bill the fracture care code only. Bill 29085 separately when: (1) a different provider performed the original fracture care and referred the patient to you for casting, or (2) recasting is required during a fracture care global period — in that case, append modifier 58 to indicate a staged or related procedure. Cast supplies (Q4013–Q4016) are separately billable in addition to the procedure fee. The global period is 000, meaning no post-procedure visits are bundled.

When an E/M is billed same-day, modifier 25 is required to show a separately identifiable evaluation occurred beyond the cast application decision itself. If the E/M falls within another procedure's global period and is unrelated to that procedure, use modifier 24 instead. Laterality modifiers LT/RT are expected by most payers; omitting them is a common clean-claim failure point.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.85
Practice expense RVU	2.19
Malpractice RVU	0.16
Total RVU	3.2
Medicare national rate	$106.88
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	$106.88
HOPD (APC 5101) Hospital outpatient department	$166.02
ASC (PI P3) Ambulatory surgical center (freestanding)	$73.51

Common denial reasons

The recurring reasons claims for CPT 29085 get rejected.

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

NCCI bundle: 29085 billed same-day with a fracture care code for the same site without a valid modifier override
Missing laterality modifier — most payers require LT or RT; claims without them reject on edit
Modifier 25 absent when an E/M is billed on the same date, causing the E/M to deny as inclusive
Recasting during a fracture care global period submitted without modifier 58, flagged as duplicate or global-period service
Cast supply codes (Q4013–Q4016) submitted without the parent procedure code 29085, or vice versa with payer-specific pairing errors

Frequently asked questions

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

01Can I bill 29085 and a fracture care code together on the same date?

Generally no. NCCI bundles casting codes into fracture care codes for the same anatomic area. Bill the fracture care code when you're performing initial treatment. Bill 29085 separately only when a different provider did the original fracture care and referred the patient to you for casting.

02What modifier do I use when recasting during a fracture care global period?

Append modifier 58 to 29085 to indicate a staged or related procedure performed during the postoperative period. Document the medical necessity — for example, cast loosening from muscle atrophy — or payers will deny it as a global-period service.

03Are cast supplies billed separately from 29085?

Yes. Per CMS guidance, Q4013 through Q4016 cover gauntlet cast supplies and are billed in addition to 29085. Supply payment is separate from the procedure fee under the physician fee schedule.

04Do I need modifier 25 when billing an E/M with 29085?

Yes. The E/M must reflect a separately identifiable service beyond the decision to apply the cast. Without modifier 25, most payers will bundle or deny the E/M as inclusive to the casting service.

05What is the global period for 29085 and what does that mean for billing?

The global period is 000 — meaning only the day of the procedure is included. No post-op visits are bundled, so follow-up visits after the cast application day can be billed separately without global-period modifiers.

06Can a hand therapist or certified hand therapist bill 29085?

A provider can report 29085 if they are qualified and credentialed to perform the service. Some payers have strict interpretations of casting codes for non-physician providers; verify coverage with the specific payer before applying the cast.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures cast type (gauntlet, hand and lower forearm), laterality, the clinical indication (fracture, post-op, dislocation), and whether this is an initial application or a recast during a global period. That specificity auto-populates the modifier logic — 58 for recasting within a global, 25 if an E/M is documented same-day — preventing the two most common denial patterns for this code.

See how Mira captures CPT 29085 documentation