Application of a one-and-one-half hip spica cast encasing the trunk and extending down both legs or one leg to the ankle and one leg to the knee.

Verified May 8, 2026 · 6 sources ↓

Medicare: $313.30
Work RVU: 2.26
Global, days: 0
Region: Hip

Drawn from CMSFastrvuAAPCFindacodeAAOS

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 exact cast configuration applied (e.g., one-and-one-half spica with extent of coverage on each leg)
Document the clinical indication — fracture diagnosis, post-surgical stabilization, or dislocation — with corresponding ICD-10 code
Record the laterality of the primary injury or surgical site
Note whether cast application was performed independently or in conjunction with a fracture treatment procedure on the same date
Document patient positioning, materials used, and any padding or windowing performed during application
If billing an E/M on the same date, document that the decision-making or history/exam was separate and distinct from the cast application itself

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 52 Reduced services 59 Distinct service 76 Repeat, same physician LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29325 covers the application of a one-and-one-half hip spica cast — a body cast that immobilizes the trunk and extends down both lower extremities, typically one leg to the ankle or foot and the other to the knee. The configuration fully restricts hip and thigh motion, making it the go-to immobilization method for pediatric femur fractures, hip dislocations, post-surgical stabilization after hip reconstruction, and select adult hip fractures when operative management isn't indicated.

The global period is 000, meaning no pre- or post-operative care is bundled. Every associated E/M service on the same date requires modifier 25 appended to the E/M code to be separately reimbursable. Cast removal, if performed later by the same or a different provider, is not included in 29325 and may be separately reported.

Site of service matters here. HOPD and ASC payments differ — see the Site of Service comparison on this page. When cast application follows a fracture treatment procedure on the same date, check NCCI edits carefully: if the cast is integral to the fracture treatment code billed, 29325 cannot be reported separately. Document the clinical rationale when billing both.

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 (2.26) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.26
Practice expense RVU	6.65
Malpractice RVU	0.47
Total RVU	9.38
Medicare national rate	$313.30
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	$313.30
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 29325 get rejected.

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

Cast application bundled into the same-day fracture treatment code without a modifier or separate clinical justification
Missing modifier 25 on a same-day E/M service, causing the evaluation to deny as included in the casting procedure
ICD-10 diagnosis code does not support the need for a full hip spica configuration (e.g., soft tissue diagnosis only)
Laterality modifiers absent when payer requires LT or RT for unilateral hip procedures
Claim submitted without documentation distinguishing 29325 from a lesser cast application code such as 29305 or 29315

Frequently asked questions

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

01What is the difference between CPT 29305, 29315, and 29325?

29305 is a hip spica cast for one leg only. 29315 adds a second leg to the thigh. 29325 — the one-and-one-half spica — extends one leg to the ankle or foot and the other to the knee. Bill the code that matches the actual cast applied; upcoding or downcoding based on convenience is an audit risk.

02Can I bill 29325 separately when I also bill a hip fracture treatment code on the same date?

Not automatically. If the cast application is integral to the fracture treatment code billed, NCCI edits prohibit separate reporting. If the cast is clinically distinct — for example, applied at a different encounter or for a separate condition — use modifier 59 or XS and document the distinction clearly.

03Does the 000 global period mean I can bill an E/M the same day?

Yes, but the E/M needs modifier 25 appended to show it was a separately identifiable service above and beyond the casting procedure. Without modifier 25, the E/M will deny as included in the global package.

04Is cast removal included in 29325?

No. The 000 global period bundles nothing beyond the application itself. Cast removal performed at a later date — by the same or a different provider — can be reported separately.

05When is modifier 50 appropriate for 29325?

A true bilateral hip spica that encases both hips symmetrically would support modifier 50. The standard one-and-one-half spica is by definition asymmetric, so most applications are unilateral and should use LT or RT instead. Verify payer preference — some require modifier 50 plus one unit, others want two line items with LT and RT.

06Does 29325 require prior authorization?

Authorization requirements vary by payer and plan. Medicare does not require prior auth for cast application, but some commercial payers and Medicaid managed care plans do, particularly for non-emergency or elective post-surgical applications. Verify before the date of service when the procedure is planned.

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 and configuration (one-and-one-half spica), leg coverage extent on each side, clinical indication, laterality, and whether the application was standalone or performed alongside a fracture treatment procedure. This prevents the most common denial scenario: a vague operative or procedure note that fails to distinguish 29325 from a lesser hip cast code or leaves the payer unable to confirm the cast wasn't already bundled into a same-day fracture care code.

See how Mira captures CPT 29325 documentation