Surgical · Hip

Application of a hip spica cast involving a single leg, used to immobilize the hip and upper thigh following fracture, surgical repair, or instability requiring rigid external support.

Verified May 8, 2026 · 7 sources ↓

Medicare: $284.58
Work RVU: 1.98
Global, days: 0
Region: Hip

Drawn from CMSMedicaid

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Indication for hip spica cast — specify diagnosis (fracture type, dislocation, post-op stabilization, developmental condition)
Laterality documented: left, right, or bilateral (bilateral = 29325, not 29305)
Cast material used (plaster vs. fiberglass) and extent of immobilization — thorax/waist to thigh/knee/ankle
Neurovascular status check performed and documented before and after cast application
Separate documentation if cast application is performed on the same date as a surgical procedure, establishing it as a distinct service
Provider identity and credential of the individual applying the cast when performed by non-physician staff under supervision

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29305 covers the application of a one-leg hip spica cast — a rigid plaster or fiberglass construct that encases the pelvis and extends down one lower extremity to immobilize the hip joint. It is used after femoral fractures, hip dislocations, pediatric developmental hip conditions, or post-operative stabilization when internal fixation alone is insufficient. The cast typically extends from the lower thorax or waist to at least mid-thigh, with some configurations reaching the ankle.

The global period is 000, meaning the day-of-service only is bundled — no pre-op or post-op follow-up is included. Any subsequent cast changes, wedging, or removal visits are separately billable. Cast supply costs are not bundled into the practice expense RVUs for facility settings; CORFs and outpatient therapy providers must bill cast materials separately using the appropriate HCPCS Level II Q-codes (Q4001–Q4049) alongside this code.

Site of service matters here. Hospital outpatient (HOPD) and ASC payments differ — see the site-of-service comparison table on this page. When 29305 is applied immediately following an operative procedure on the same date, modifier 59 or XS may be required to bypass NCCI bundling edits if a separate, distinct service is being reported.

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 (1.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.52) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.98
Practice expense RVU	6.12
Malpractice RVU	0.42
Total RVU	8.52
Medicare national rate	$284.58
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	$284.58
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 29305 get rejected.

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

Bilateral hip spicas billed under 29305 — bilateral application requires 29325, not 29305 with modifier 50
Cast supply HCPCS Q-codes missing on facility/CORF claims — materials are not bundled and must be billed separately with Q4001–Q4049
Bundling denial when reported same-day with a surgical procedure without modifier 59 or XS to distinguish the cast application as a separate service
Missing laterality on the claim or operative note when payer edits require RT or LT modifiers
Incorrect global period assumption — 29305 carries a 000 global, so post-op cast change visits are separately payable but must be billed correctly

Frequently asked questions

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

01Does CPT 29305 include cast removal and follow-up visits?

No. The global period is 000 — only the date of service is bundled. Cast removal, cast changes, and all subsequent visits are separately billable.

02Should I use modifier 50 or bill 29325 for a bilateral hip spica?

Use 29325 — that code specifically describes bilateral hip spica application. Don't bill 29305 with modifier 50; that's a coding error and will likely deny.

03Can 29305 be billed the same day as a surgical procedure?

Yes, but you need modifier 59 or XS to bypass NCCI bundling edits and establish that the cast application is a distinct, separate service from the operative procedure.

04Are cast materials included in the payment for 29305?

Not in facility or CORF settings. Those providers must separately bill cast supply materials using HCPCS Level II Q-codes Q4001–Q4049 alongside 29305. Under the Medicare Physician Fee Schedule, practice expense RVUs account for supplies in the non-facility setting.

05Is 29305 subject to SNF consolidated billing?

Yes. CPT 29305 is not on the SNF consolidated billing exclusion list, which means Medicare will not pay separately for this service when billed by a non-SNF provider for a beneficiary in a covered Part A SNF stay.

06Do payers require LT or RT modifiers on 29305?

Many commercial payers and some MACs require laterality modifiers. Document laterality in the operative note and append LT or RT on the claim line to avoid edits — even though the code descriptor implies a single leg.

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 (plaster vs. fiberglass), exact anatomical extent of immobilization, laterality, indication, and the post-application neurovascular check from dictation. That prevents the two most common 29305 denials: missing laterality triggering payer edits, and vague operative notes that auditors flag when the cast is billed same-day with a surgical procedure.

See how Mira captures CPT 29305 documentation