Unlisted/special orthopedic casting and strapping
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Body cast application billed without fracture or spinal pathology requiring immobilization
Occasional29000 (body cast shoulder to hips) requires significant pathology: spinal fracture, scoliosis requiring casting, post-op immobilization. Large cast application uncommon - must document medical necessity. Denied when diagnosis doesn't support extensive immobilization or when simpler bracing adequate.
Common Causes
- • Body cast for minor back pain - not medically necessary
- • No fracture or deformity documented requiring casting
- • Post-op immobilization when surgeon preference only, not required
Resolution Strategy
Document medical necessity: 'Patient with unstable T12 compression fracture. Body cast applied from shoulders to hips for fracture immobilization, allowing healing in proper alignment. Cast molded with patient supine, appropriate padding applied to pressure points.' Must document: specific diagnosis requiring casting (fracture, deformity), why removable brace inadequate, proper cast application technique. If removable brace adequate, insurance may deny casting. Appeal with imaging showing fracture/deformity and explanation why cast necessary.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For unusual or unlisted orthopedic casting, splinting, or strapping procedures not specifically identified elsewhere
Common Scenarios
Documentation Requirements
- Injury or condition being immobilized
- Type of material and method used
- Anatomic location and extent
- Duration of immobilization
- Medical necessity for specialized approach
Coding Guidelines
Common Modifiers
Bundling Rules
- Special report often required
- May require comparison to standard codes
- Includes materials and labor
Exclusions
- Standard casting/strapping uses specific codes
- Upper extremity casting uses 29010-29080 series
- Lower extremity casting uses 29345-29450 series
Coding Notes
Clinical scenarios
- Injury or condition being immobilized
- Type of material and method used
- Anatomic location and extent
- Injury or condition being immobilized
- Type of material and method used
- Anatomic location and extent
- Injury or condition being immobilized
- Type of material and method used
- Anatomic location and extent
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 29000 is the billing code for "Unlisted/special orthopedic casting and strapping". For unusual or unlisted orthopedic casting, splinting, or strapping procedures not specifically identified elsewhere
Medicare pays approximately $365.19 for CPT 29000 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 29000 has a total RVU of 4.77, broken down as: Work RVU 2.15, Practice Expense RVU 2.41, and Malpractice RVU 0.21. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 29000 is "Body cast application billed without fracture or spinal pathology requiring immobilization". 29000 (body cast shoulder to hips) requires significant pathology: spinal fracture, scoliosis requiring casting, post-op immobilization. Large cast application uncommon - must document medical necessity. Denied when diagnosis doesn't support extensive immobilization or when simpler bracing adequate. Common causes include: Body cast for minor back pain - not medically necessary; No fracture or deformity documented requiring casting. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 29000 include: Injury or condition being immobilized; Type of material and method used; Anatomic location and extent; Duration of immobilization. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 29000: Special report often required. May require comparison to standard codes Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 29000 include: 22 (Increased procedural services if applicable), 76 (Repeat procedure by same physician). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 29000 is 30-45 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.