Application of a long leg cast brace extending from the thigh to the foot, incorporating a hinged or flexible brace mechanism that allows controlled knee motion while immobilizing the leg during fracture or post-operative healing.

Verified May 8, 2026 · 6 sources ↓

Medicare: $183.04
Work RVU: 1.39
Global, days: 0
Region: Knee

Drawn from CMSMdclarityAAPCGomedicalbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify laterality explicitly (left, right, or bilateral) in the procedure note
Document the clinical indication — fracture type, post-op status, or diagnosis driving the need for a long leg cast brace rather than a standard long leg cast
Record that the device extends from the thigh to the foot and includes a brace/hinge component allowing knee flexion, distinguishing it from 29345 or 29365
Note the treating provider's name, date of application, and the patient's ability to bear weight if ambulation was permitted
Document any padding, liner materials, or modifications made to the cast brace at the time of application

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29358 covers the application of a long leg cast brace — a hybrid device that runs thigh to foot and includes a brace component allowing the knee to flex. That distinguishes it from a standard long leg cast (29345) or cylinder cast (29365), which lock the knee in full extension. The brace-cast design is used when the treating provider wants to maintain some knee range of motion during healing, particularly with femur fractures managed non-operatively or in early post-operative ambulation protocols.

The global period is 000, meaning the day-of-service is the only bundled period. Any follow-up cast changes, adjustments, or office visits the following day are separately billable. Because 29358 falls under SNF Consolidated Billing inclusion rules, Medicare Part A SNF stays bundle this service — you cannot bill it separately to Part B when the patient is in a Part A SNF stay.

Site of service matters here. HOPD payment is substantially higher than ASC payment (see the Site of Service comparison table). If you're applying the cast brace in a physician office or clinic, bill under the PFS. The 000 global means no post-op visits are included — bill each follow-up encounter on its own merits.

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 (1.39) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.48) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.39
Practice expense RVU	3.8
Malpractice RVU	0.29
Total RVU	5.48
Medicare national rate	$183.04
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	$183.04
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$127.56

Common denial reasons

The recurring reasons claims for CPT 29358 get rejected.

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

Laterality missing — payers and MACs flag claims without LT or RT when a bilateral modifier is not present
Upcoding flag when documentation describes a standard long leg cast without a brace/hinge component — use 29345 or 29355 if no brace mechanism was applied
Bundled payment rejection when billed separately under Medicare Part B during an active Part A SNF stay — 29358 is a SNF Consolidated Billing inclusion code
Lack of medical necessity documentation when no fracture, post-operative status, or qualifying diagnosis is linked to the claim
Incorrect site of service code causing payment mismatch between the physician fee schedule rate and the facility rate

Frequently asked questions

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

01What separates 29358 from 29345?

29345 is a standard long leg cast — no brace, fixed position. 29358 includes a brace mechanism that allows controlled knee flexion. If there's no hinge or brace component, use 29345.

02Does 29358 have a global period that bundles follow-up visits?

No. The global period is 000 — only the day of service is bundled. Follow-up visits and cast changes the next day and beyond are separately billable.

03Can I bill 29358 separately when my patient is in a Medicare Part A SNF stay?

No. 29358 is listed as a SNF Consolidated Billing inclusion code. Medicare bundles it into the Part A SNF payment — you cannot bill it separately to Part B during an active Part A stay.

04Do I need a laterality modifier?

Yes. Append LT or RT on every single-leg claim. If you apply cast braces to both legs in one encounter, use modifier 50 and document the bilateral indication clearly.

05When is modifier 76 appropriate for 29358?

Use modifier 76 if the same provider reapplies a long leg cast brace to the same extremity on the same date — for example, after a failed initial application requiring a redo. Document the reason for repeat application.

06Can 29358 be billed with an E/M on the same date?

Yes, if the E/M is a separately identifiable service beyond the decision to apply the cast brace. Append modifier 25 to the E/M. The 000 global period does not restrict same-day E/M billing the way a 90-day global would.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the device type (cast brace with knee hinge versus standard long leg cast), the anatomical extent from thigh to foot, laterality, the clinical indication, and whether weight-bearing was authorized at time of application. That specificity prevents the most common audit flag for 29358: operative or procedure notes that don't distinguish the brace component from a plain long leg cast, which reviewers use to downcode to 29345.

See how Mira captures CPT 29358 documentation