Repair of a spica cast, body cast, or jacket cast that has deteriorated, cracked, or loosened and requires reinforcement to maintain proper immobilization.

Verified May 8, 2026 · 5 sources ↓

Medicare: $98.20
Total RVUs: 2.94
Global, days: 0
Region: Multi-region

Drawn from CMSAshlinkEmednyGenhealthCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identity of the entity that applied the original cast — must be a different provider or practice than the one performing the repair
Nature of the cast damage: specify whether the issue is cracking, softening, structural separation, or loosening
Cast type documented explicitly — spica, body cast, or jacket — not generic 'large cast'
Clinical rationale for repair rather than full cast replacement, including assessment of remaining cast integrity
Anatomic region and laterality if applicable (e.g., right hip spica)

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 76 Repeat, same physician 77 Repeat, another physician LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 29720 covers the repair — not removal or replacement — of large-format rigid casts: hip spica, body cast, or jacket cast. The work involves fixing structural damage such as cracks, soft spots, or loosened sections that would otherwise compromise immobilization. This is distinct from windowing (29730) or wedging (29740), which are separate cast modification procedures.

The single most important billing rule: 29720 is only billable when the original cast was applied by a different provider or entity. If your practice applied the cast, repair is considered part of that service and cannot be billed separately — regardless of how much time the repair takes. This rule applies across the entire 29700–29750 removal and repair family.

The global period is 000, meaning no post-procedure visits are bundled. If the cast repair is performed during a separately identifiable E/M visit — for example, a follow-up where the provider also evaluates the patient's underlying condition — append modifier 25 to the E/M to support both claims. Cast supply materials billed separately use HCPCS A4580 (plaster) or A4590 (fiberglass).

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.66
Practice expense RVU	2.14
Malpractice RVU	0.14
Total RVU	2.94
Medicare national rate	$98.20
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	$98.20
HOPD (APC 5101) Hospital outpatient department	$166.02
ASC (PI P3) Ambulatory surgical center (freestanding)	$71.83

Common denial reasons

The recurring reasons claims for CPT 29720 get rejected.

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

Same-entity rule violation: repair billed by the same provider or practice that applied the original cast
Bundled with a same-day musculoskeletal procedure (20100–28899, 29800–29999) for the same anatomic area
Missing documentation of what structural damage was repaired — notes say 'cast adjusted' without specifying defect
Modifier 25 absent on a same-day E/M, causing the E/M to deny as bundled with the cast repair

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 29720 if my practice applied the original cast?

No. CPT guidelines bar billing any repair or removal code in the 29700–29750 range when the same entity that applied the cast also performs the repair. The repair is considered part of the original application service.

02What is the global period for 29720?

Zero days (000). No post-procedure visits are bundled, but this also means payers expect the cast repair itself to be the standalone service — not a bundled component of a fracture care global.

03Can I bill a separate E/M on the same day as 29720?

Yes, if you perform a separately identifiable evaluation beyond the cast repair decision. Append modifier 25 to the E/M. Without it, most payers will deny the E/M as incidental to the procedure.

04Should I also bill cast supply codes like A4580 or A4590 with 29720?

Yes, if new casting material is used during the repair. A4580 covers plaster supplies and A4590 covers fiberglass or other special casting material. Bill these separately under HCPCS.

05How does 29720 differ from 29710 (removal of spica or Risser jacket)?

29710 is used when you are fully removing or bivalving the cast. 29720 is repair only — the cast stays in place but is structurally restored. Do not use 29720 if the cast is being taken off entirely.

06Is 29720 billable during a fracture care global period from another provider?

If the cast repair is unrelated to the global procedure or performed by a different surgeon, modifier 79 (unrelated procedure during global) applies. If it is related to the original operative injury and unplanned, use modifier 78.

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 (spica, body, or jacket), the specific structural defect repaired (crack location, softened section, loosened segment), and a confirmation that the original cast was applied by a different provider or entity. That last detail is the linchpin — without it in the note, the same-entity rule denial has no defense on appeal.

See how Mira captures CPT 29720 documentation