Application of a short leg cast extending from below the knee to the toes for immobilization of lower extremity injuries.

Verified May 8, 2026 · 6 sources ↓

Medicare: $87.84
Total RVUs: 2.63
Global, days: 0
Region: Foot & ankle

Drawn from CMSAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis supporting medical necessity (fracture, acute injury, or post-op immobilization) with corresponding ICD-10-CM code
Laterality documented explicitly (left, right, or bilateral) to support LT/RT/50 modifier use
Cast material type noted (plaster vs. fiberglass) and clinical rationale for rigid immobilization over a splint or walking boot
Documentation of the extent of the cast — confirm it extends from below the knee to the toes, not just a partial foot or ankle splint
For same-day E/M with modifier 25, a separately identifiable history, exam, and medical decision-making must be documented — not just casting instructions
For recasting or replacement, document the clinical reason (e.g., swelling reduced, cast integrity compromised, planned exchange)

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29405 covers the application of a short leg cast (below-knee to toes) — the standard go-to code for ankle fractures, stable distal fibula fractures, foot injuries, and other conditions requiring rigid immobilization below the knee. The 000-day global period means no post-application visits are bundled; each follow-up is billed separately. Cast supplies (fiberglass or plaster) are generally not separately reimbursable under Medicare — they're considered part of the procedure — though some commercial payers allow separate HCPCS supply billing.

Billing an E/M visit on the same day as cast application is common and generally appropriate when a separately identifiable evaluation occurs. Use modifier 25 on the E/M code to distinguish it from the casting service itself. If the cast is applied to both legs at the same encounter (rare, but it happens), bill with modifier 50 or with LT and RT on separate line items depending on payer preference.

For cast changes or replacement, 29405 with modifier 58 applies when the original and replacement casts are part of a planned staged treatment sequence. Modifier 76 covers a same-day repeat application by the same provider on the same limb. Payers differ on whether cast change codes (29425) or a repeat 29405 are preferred for recasting — verify before billing.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.78
Practice expense RVU	1.72
Malpractice RVU	0.13
Total RVU	2.63
Medicare national rate	$87.84
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	$87.84
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$57.74

Common denial reasons

The recurring reasons claims for CPT 29405 get rejected.

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

E/M billed same-day without modifier 25, causing the visit to be bundled into the casting procedure
Laterality not documented or modifier LT/RT omitted when payer requires side designation
Cast supply codes (HCPCS) billed separately to Medicare, which considers them bundled into 29405
29405 billed for a splint application — splints (e.g., 29515) are distinct codes and swapping them triggers NCCI bundling edits or downcoding
Modifier 58 missing when recasting during a staged treatment plan, causing the second cast claim to be denied as a duplicate

Frequently asked questions

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

01Can I bill an office visit (E/M) on the same day I apply a short leg cast?

Yes, but append modifier 25 to the E/M code. The evaluation must be separately documented — a standalone assessment of the injury distinct from the casting procedure itself. Without modifier 25, the E/M will be bundled into 29405 and denied.

02What's the difference between 29405 and 29515?

29405 is a rigid short leg cast (plaster or fiberglass). 29515 is a short leg splint — non-circumferential, designed to accommodate swelling. Billing one when the other was applied is a documentation mismatch that invites audit or downcoding.

03How do I bill a cast change or replacement?

Use 29405 with modifier 58 if the replacement is part of a planned staged treatment. If the same provider repeats the application on the same day due to an unforeseen issue, use modifier 76. For a subsequent cast change, some payers prefer 29425 (walking cast) or another applicable cast change code — verify by payer before defaulting to a repeat 29405.

04Are cast supplies separately billable under Medicare?

No. Medicare considers casting materials (plaster, fiberglass rolls, padding) part of the 29405 procedure. Some commercial payers allow separate HCPCS supply billing — check your contracts. Billing supply codes to Medicare on the same claim as 29405 will trigger a bundling denial.

05Does 29405 have a global period that affects follow-up billing?

The global period is 000, meaning no post-op visits are included. Every follow-up after the casting date is billed separately with the appropriate E/M code. There's no modifier 24 or 79 required for routine follow-up visits.

06When is modifier 50 appropriate for 29405?

Only when casts are genuinely applied to both lower extremities at the same encounter. Bilateral short leg casting is uncommon but does occur in certain neurological or post-surgical scenarios. Use modifier 50 or separate LT/RT line items depending on your payer's preference — check before billing.

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 cast type (short leg, fiberglass or plaster), laterality, injury diagnosis, and whether a separate E/M was performed at the same encounter. It flags when documentation describes a splint rather than a rigid cast — a distinction that determines whether 29405 or 29515 is correct — and prompts for modifier 25 when a distinct evaluation is dictated alongside the casting note.

See how Mira captures CPT 29405 documentation