Wedging of an existing cast to correct fracture alignment without surgical intervention.

Verified May 8, 2026 · 7 sources ↓

Medicare: $109.55
Work RVU: 1.09
Global, days: 0
Region: General

Drawn from AAPCJposnaSciencedirectCMSNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Pre- and post-wedging radiographs documenting the fracture alignment before and after the procedure
Explicit identification of the wedging technique used (opening, closing, or combination wedge)
Clinical rationale for why realignment was necessary at this visit
Confirmation that the case does not involve a clubfoot cast, which is excluded from this code
Documentation of additional casting material used to stabilize the wedge if applicable
Notation of the body part and the originally applied cast being modified

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29740 describes the mechanical adjustment of a previously applied cast by cutting into it and inserting wedges to realign an underlying long bone fracture. The technique—opening wedge, closing wedge, or combination—corrects angulation without sedation or surgical incision. Post-wedging radiographs confirm alignment before the wedge is stabilized with additional casting material.

This code carries a 000-day global period, meaning each wedging encounter is separately billable. When performed during the global period of a fracture management code, modifier 58 is required to signal that the wedging is a staged, excluded service—not a repeat of the primary procedure. The code explicitly excludes clubfoot casts; wedging of a clubfoot cast is not reported here.

Place of service affects payment significantly. In a physician office (POS 11), cast supply codes (Q-codes) may be reported separately by the billing provider if supplies are a practice expense. In a hospital outpatient or ASC setting, cast materials are bundled into facility fees and are not separately billable by the physician.

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 (1.09) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.28) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.09
Practice expense RVU	1.97
Malpractice RVU	0.22
Total RVU	3.28
Medicare national rate	$109.55
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	$109.55
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI P3) Ambulatory surgical center (freestanding)	$66.13

Common denial reasons

The recurring reasons claims for CPT 29740 get rejected.

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

Missing modifier 58 when billed during the global period of a fracture management code — payers treat it as included in the global and deny without it
Billed for wedging of a clubfoot cast, which is outside the scope of this code and will be rejected
Lack of pre- and post-wedging imaging documentation to support medical necessity
Cast supply codes billed separately in a hospital outpatient or ASC setting where supplies are bundled into facility fees
Insufficient documentation of the distinct clinical reason for realignment, causing medical necessity denials on audit

Frequently asked questions

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

01Do I need modifier 58 every time I bill 29740 during a fracture global period?

Yes. Cast wedging is explicitly excluded from the global fracture service under CPT guidelines, but payers won't know that without modifier 58. Bill 29740-58 to signal it's a staged, distinct service — not included in the original fracture management package.

02Can I bill 29740 for wedging a clubfoot cast?

No. Clubfoot cast wedging is explicitly excluded from CPT 29740. Using this code for a clubfoot cast will result in denial. A different reporting approach is required for that clinical scenario.

03Can I bill cast supply Q-codes in addition to 29740?

In a physician office (POS 11), yes — if cast materials are a direct expense to the practice, the appropriate Q-code is separately reportable. In a hospital outpatient or ASC setting, cast supplies are bundled into facility fees and are not billable by the physician.

04What's the global period for 29740, and what does that mean for follow-up?

The global period is 000 days. Each wedging visit stands alone — there is no built-in post-procedure follow-up bundled into this code. Subsequent E/M visits for fracture management fall under whatever global period the underlying fracture code carries.

05How do I bill 29740 if the same physician who applied the original cast is performing the wedging?

Bill 29740-58 if within the global period of the fracture management code. The wedging is a staged procedure excluded from the global, but modifier 58 is required to override the bundling edit and allow separate payment.

06Is 29740 appropriate if the wedging was done to relieve pressure or accommodate swelling rather than to correct fracture alignment?

The primary clinical indication for 29740 is fracture realignment. If you're modifying a cast purely for comfort or swelling without a realignment goal, medical necessity documentation must clearly support that the structural adjustment was clinically required — otherwise the claim is vulnerable to denial.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the wedging technique (opening, closing, or combination), the anatomic site, the clinical indication for realignment, and the pre- and post-wedging radiographic findings from dictation. It also flags when the encounter falls within a fracture management global period and prompts attachment of modifier 58. This prevents denials from payers treating the wedging as included in the global package and eliminates audit flags from missing imaging documentation.

See how Mira captures CPT 29740 documentation