Application of a rigid total contact leg cast intended for non-weight bearing or limited-weight bearing clinical management.

Verified May 8, 2026 · 7 sources ↓

Medicare: $132.27
Total RVUs: 3.96
Global, days: 0
Region: Foot & ankle

Drawn from CMSIntellicureElitemedfinancialsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicit statement of non-weight bearing or limited-weight bearing clinical intent — required by the 2026 descriptor
Diagnosis supporting TCC use (e.g., diabetic plantar ulcer, Charcot neuroarthropathy, specific fracture type)
Laterality documented (left vs. right leg) to support LT/RT modifier assignment
If billed same-day as debridement on a different limb, separate procedure notes for each anatomic site to support modifier XS
Cast materials and application technique described; supplies are bundled and must not be itemized on the claim

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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29445 covers application of a rigid total contact cast (TCC) to the lower leg. As of 2026, the descriptor explicitly requires documentation of non-weight bearing or limited-weight bearing clinical intent — this isn't just good practice, it's part of the code definition. TCCs are most commonly applied for diabetic foot ulcers, Charcot neuroarthropathy, and select fracture management scenarios requiring maximal off-loading.

All supplies used to fabricate and apply the TCC are bundled into 29445 — bill them separately and expect denial. The critical NCCI rule: 29445 is paired with debridement codes 11042–11047 and selective debridement codes 97597/97598. If the TCC and debridement are performed on the same limb at the same encounter, bill only the debridement. The TCC application is considered an integral component of the debridement service for that site. The only pathway to billing both is modifier XS, and only when the procedures are genuinely performed on different limbs with separate documentation for each site.

29445 carries a 000-day global period, meaning no post-op services are bundled — each subsequent encounter bills independently. The code appears predominantly in podiatry, physical medicine and rehabilitation, and family practice 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	1.74
Practice expense RVU	2.02
Malpractice RVU	0.2
Total RVU	3.96
Medicare national rate	$132.27
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	$132.27
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$68.14

Common denial reasons

The recurring reasons claims for CPT 29445 get rejected.

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

Bundling with same-day debridement (11042–11047 or 97597/97598) on the same limb without a valid NCCI modifier
Missing documentation of non-weight bearing or limited-weight bearing intent, which became a descriptor requirement in 2026
Separate billing of cast supplies (padding, fiberglass, etc.) already bundled into the 29445 reimbursement
Laterality modifier absent when payer requires LT or RT for unilateral lower extremity procedures
Medical necessity not established — diagnosis code does not support TCC application (e.g., no documented ulcer, Charcot, or appropriate fracture)

Frequently asked questions

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

01Can I bill 29445 and a debridement code on the same day?

Not for the same limb. NCCI PTP edits pair 29445 with 11042–11047 and 97597/97598. When both are performed on the same site at the same encounter, bill only the debridement. If the TCC and debridement are genuinely on different limbs, append modifier XS to 29445 and document each site separately.

02What changed about CPT 29445 in 2026?

The 2026 descriptor was revised to require documentation of non-weight bearing or limited-weight bearing clinical intent. This is now a billing requirement, not just clinical context. Notes that don't state this intent explicitly are vulnerable to denial or audit.

03Are cast supplies billable separately from 29445?

No. All materials used to apply the TCC — padding, casting tape, stockinette — are bundled into the 29445 reimbursement per CMS policy. Itemizing supplies on the claim will trigger denial.

04What global period applies to 29445?

000-day global. No services are bundled post-procedure. Each follow-up visit bills independently, which also means no modifier 24 or 79 complications arise from this code.

05When is modifier 50 appropriate for 29445?

Bilateral TCC application is clinically unusual, but if both legs are casted in the same session, modifier 50 applies. Payer policies vary — some require LT and RT on separate lines instead of modifier 50 on a single line. Verify with the specific payer before submitting.

06Which diagnosis codes best support 29445 medical necessity?

Diabetic plantar ulcers (typically E11.621 with an L-code for the wound), Charcot neuroarthropathy (M14.67x), and select lower extremity fractures requiring off-loading are the primary indications. The diagnosis must align with the non-weight bearing or limited-weight bearing intent stated in the note.

07Can 29445 be billed in an office setting, or is facility billing required?

29445 is routinely billed in office (place of service 11) and on-campus outpatient hospital settings (POS 22). The site of service affects payment rate — see the Site of Service comparison table for HOPD vs. non-facility amounts.

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 clinician's stated weight-bearing intent (non-weight bearing vs. limited-weight bearing), the specific indication (ulcer grade, Charcot stage, fracture type), laterality, and cast materials used — all from dictation. That prevents the most common 29445 denial in 2026: a claim where the non-weight bearing intent is nowhere in the note and the new descriptor requirement goes unmet.

See how Mira captures CPT 29445 documentation