Application of a long leg cast extending from the thigh down to and including the toes, used to immobilize the knee and lower leg.

Verified May 8, 2026 · 6 sources ↓

Medicare: $148.97
Work RVU: 1.37
Global, days: 0
Region: Foot & ankle

Drawn from CMSEmednyAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis driving the need for long leg immobilization (fracture site, deformity, dislocation) with corresponding ICD-10 code
Explicit documentation that the cast extends from the thigh to the toes — not just 'long leg cast applied'
Laterality documented (right vs. left leg) to support RT/LT modifiers and avoid claim rejection
Clinical rationale for full-length immobilization vs. a shorter construct such as a cylinder cast or short leg cast
Cast material type and any molding technique used, particularly if modifier 22 is appended for increased complexity
Provider identity and supervision level if cast is applied by a technician or resident under physician supervision

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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 29345 covers the application of a long leg cast running from the thigh to the toes, leaving only the tips of the toes exposed. It is used to immobilize fractures of the femur, tibia, or fibula, and to stabilize deformities or injuries involving the knee, distal leg, ankle, or foot when full-length immobilization is clinically required. The cast must be molded to maintain proper alignment; this is not a splint application.

This code carries a 0-day global period, meaning there is no bundled post-op period — each subsequent encounter, including cast checks and replacements, can be billed separately. Cast removal (29705) is separately reportable only when a different physician removes a cast applied by another provider.

Differentiate 29345 from nearby codes before billing: 29365 is a cylinder cast (thigh to ankle, foot excluded); 29355 is a walker or ambulatory version of the long leg cast; 29358 is a long leg cast brace. Using the wrong code for the construct applied is a common audit trigger.

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 (1.37) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.46) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.37
Practice expense RVU	2.83
Malpractice RVU	0.26
Total RVU	4.46
Medicare national rate	$148.97
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	$148.97
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$95.00

Common denial reasons

The recurring reasons claims for CPT 29345 get rejected.

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

Wrong code selected — 29365 (cylinder cast, thigh to ankle) or 29355 (ambulatory type) billed when 29345 is the correct construct
Missing laterality — payers with RT/LT edit requirements reject claims without a side modifier
Cast application billed same-day as a fracture treatment code without modifier 59 when the cast is integral to a separately payable procedure
Insufficient documentation of extent — note says 'cast applied' without confirming thigh-to-toe coverage, triggering medical necessity denial
Duplicate billing — cast replacement by the same physician on the same date submitted without modifier 76

Frequently asked questions

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

01What is the global period for CPT 29345?

Zero days. There is no bundled post-op period, so follow-up cast checks, replacements, and E/M visits can be billed separately without a modifier.

02Do I need RT or LT modifiers on 29345?

Yes for most payers. While Medicare doesn't universally mandate laterality modifiers on cast codes, many commercial payers and state Medicaid programs require RT or LT. Apply them by default to avoid site-specific rejections.

03How does 29345 differ from 29365 and 29355?

29345 covers thigh to toes with the foot enclosed. 29365 is a cylinder cast — thigh to ankle with no foot coverage. 29355 is a walker or ambulatory version of the long leg cast. Bill the code that matches the actual construct applied.

04Can I bill 29345 and a fracture treatment code on the same day?

It depends on the fracture code. Many fracture treatment codes include cast application as part of the procedure — check NCCI PTP edits before unbundling. When the cast is applied separately and distinct, modifier 59 supports separate billing, but documentation must support that distinction.

05If I replace a long leg cast at a follow-up visit, do I bill 29345 again?

Yes, with modifier 76 if you applied the original cast, or modifier 77 if a different physician applied it. Because the global period is 0 days, the replacement is separately reimbursable.

06When is modifier 22 appropriate for 29345?

Use modifier 22 when the application required substantially more work than typical — for example, significant manipulation to achieve reduction or alignment before casting in a complex deformity. Document the added time and difficulty explicitly; without that, payers will reject the upcharge.

Sources & references

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

Mira Scribe

The Mira AI Scribe captures cast extent (thigh to toes), laterality, diagnosis, and clinical rationale for full-length immobilization directly from physician dictation. This prevents the two most common denials for 29345: missing laterality and vague cast description that auditors flag as insufficient to distinguish 29345 from 29365 or 29405.

See how Mira captures CPT 29345 documentation