Surgical · Hand

Application of a cast to a finger, including fabrication of the cast, typically for immobilization following injury or to address a flexion contracture.

Verified May 8, 2026 · 6 sources ↓

Medicare: $82.50
Total RVUs: 2.47
Global, days: 0
Region: Hand

Drawn from CMSMcwebAAPCEatonhandOpenpayer

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the digit(s) treated by name or number (e.g., right index finger, left ring finger PIP joint)
Document the clinical indication — fracture, dislocation, contracture — with ICD-10 code tied directly to the finger treated
Record the cast material used (plaster vs. fiberglass); fiberglass triggers modifier 59 under some Medicaid NCCI edits
Note the type of cast and joints immobilized (e.g., finger cast encasing the PIP joint)
If applied by a therapist, include functional goal and how immobilization supports the treatment plan
For repeat applications, document why replacement was necessary (cast damage, skin issues, position change)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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 6 cited references ↓

CPT 29086 covers applying and fabricating a finger cast — most often for a traumatic injury (fracture, dislocation) or a flexion contracture requiring static progressive immobilization. The code sits in the body and upper extremity casting section and carries a 0-day global period, meaning each encounter bills independently with no bundled pre- or post-op window.

Physical and occupational therapists bill this code nearly as often as orthopedic surgeons. CMS explicitly includes 29086 in its outpatient therapy billing guidance, but flags that more than 8–10 casting visits without escalating documentation is a coverage risk. The casting code captures the application work only — cast material is reported separately via HCPCS supply codes, not bundled into the procedure code.

Medi-Cal and other Medicaid programs note that when fiberglass is the casting material for codes in the 29000–29086 range, modifier 59 is specifically required to distinguish the service. Always append LT or RT to lateralize the digit; payers treating fingers as bilateral structures may otherwise flag the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.6
Practice expense RVU	1.82
Malpractice RVU	0.05
Total RVU	2.47
Medicare national rate	$82.50
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	$82.50
HOPD (APC 5101) Hospital outpatient department	$166.02
ASC (PI P3) Ambulatory surgical center (freestanding)	$61.09

Common denial reasons

The recurring reasons claims for CPT 29086 get rejected.

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

Missing laterality — no LT or RT modifier appended, causing claim to reject or pend
Cast material billed within the procedure code rather than separately via HCPCS supply code
Therapy providers billing beyond 8–10 sessions without documentation of ongoing medical necessity
CCI edit conflict when billed same-day as PT/OT evaluation codes 97161–97168 without modifier 59
ICD-10 code references the hand or wrist rather than the specific finger, mismatching the procedure site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does 29086 have a global period?

Zero-day global. Each casting visit bills independently. There is no bundled post-op window, so follow-up cast checks bill under an E/M code without needing modifier 24.

02Can a physical or occupational therapist bill 29086?

Yes. CMS includes 29086 in its outpatient therapy billing guidance. Therapists in private practice are among the top billing specialties for this code. Document the therapeutic rationale and functional goal in the treatment plan.

03Is cast material included in 29086?

No. The procedure code covers application and fabrication labor only. Report cast supplies separately using the appropriate HCPCS Level II supply code. Bundling material cost into the procedure code is a common audit flag.

04When does modifier 59 apply to 29086?

Append modifier 59 when fiberglass casting material is used under Medi-Cal and similar Medicaid programs — their NCCI implementation specifically requires it for codes in the 29000–29086 range with fiberglass. Also use 59 if billing 29086 same-day with a distinct procedure that would otherwise trigger a CCI edit.

05Can 29086 be billed same-day as an E/M visit?

Yes, with modifier 25 on the E/M if the visit represents a separately identifiable service beyond the decision to apply the cast. Because the global period is zero days, modifier 24 is not relevant here — that applies inside an active global period.

06How do you handle casting of multiple fingers on the same date?

Bill a separate unit of 29086 for each finger cast, appending modifier 51 on the secondary lines and laterality modifiers (LT or RT) on each. Document each digit's indication separately — a single note covering all fingers without per-digit detail invites a medical necessity denial.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific digit (by name and number), the joint(s) immobilized, the clinical indication (fracture, contracture, dislocation), and the cast material from dictation. That detail populates laterality modifiers automatically and ensures the ICD-10 maps to the correct finger — the mismatch that most often triggers a site-of-service or specificity denial.

See how Mira captures CPT 29086 documentation