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CPT code 29435: PTB cast, below knee2026 Medicare rate & RVUs in Hawaii, Guam, HI

Report application of a below-knee patellar tendon-bearing cast when its design transfers weight through the patellar tendon, such as in selected tibial fractures.

CMS RVU26DEffective Oct 1, 2026One payment locality71 Medicare services in 2024

In Hawaii, Guam, HI, Medicare pays $148.63 for 29435 in the office and $82.55 when it’s performed in a hospital or facility.

$148.63Office (non-facility)
$82.55Hospital or facility
+6.7%vs the national office rate ($139.28)

Check a contract rate as a % of Medicare · 29435 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 29435 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Hawaii, Guam, HI
  2. What 29435 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 29435 covers

This service involves applying a below-knee cast shaped to transfer weight-bearing load through the patellar tendon region rather than directly onto the lower leg. An orthopedic clinician may use this design for selected tibial fractures when protected or progressive weight bearing is part of the plan. The cast is distinct from an ordinary short-leg cast and from a walking cast that does not use the patellar tendon-bearing design.

Report the cast application when that service is separately reportable; cast application is included when the reported fracture-treatment service already includes it. Documentation should identify the treated side, the clinical indication, and the PTB cast design. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Hawaii, Guam, HI compares for 29435

Across 109 of 109 payment localities, the office rate for 29435 runs from $122.30 in Arkansas to $180.83 in San Benito County, CA. Hawaii, Guam, HI pays $148.63. The RVUs are the same everywhere; the geographic indexes change the dollars.

29435 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$148.63
  2. Los Angeles, CA · California$155.16+$6.53
  3. Washington, DC area · District of Columbia$158.79+$10.16
  4. Miami, FL · Florida$155.35+$6.72
  5. Chicago, IL · Illinois$150.40+$1.77
  6. Manhattan, NY · New York$161.48+$12.85
  7. Alaska · Alaska$160.92+$12.29

Other areas in Hawaii first, then benchmark localities. Bars start at $0.

Every other payment area

29435 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$124.20$73.34
ArkansasArkansas$122.30$72.38
ArizonaArizona$135.25$78.93
Bakersfield, CACalifornia$145.79$82.09
Chico, CACalifornia$145.13$81.43
El Centro, CACalifornia$145.17$81.47
Fresno, CACalifornia$145.13$81.43
Hanford, CACalifornia$145.13$81.43

29435 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$122.30

$162.98

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
29435 office rate range by state
State / territoryOffice rate rangeLocalities
AK$160.921
AL$124.201
AR$122.301
AZ$135.251
CA$145.13–$180.8329
CO$143.931
CT$148.881
DC$158.791
DE$137.551
FL$139.23–$155.353
GA$130.79–$142.492
GU$148.631
HI$148.631
IA$126.561
ID$127.631
IL$135.72–$150.404
IN$128.381
KS$126.391
KY$128.291
LA$128.27–$134.892
MA$143.19–$157.992
MD$140.12–$158.793
ME$128.82–$135.492
MI$132.24–$141.532
MN$136.331
MO$126.26–$134.843
MS$124.281
MT$139.271
NC$130.171
ND$134.521
NE$127.151
NH$142.091
NJ$150.14–$157.102
NM$133.191
NV$138.041
NY$132.26–$166.165
OH$131.271
OK$127.561
OR$136.53–$148.152
PA$131.23–$145.332
PR$140.181
RI$142.211
SC$131.021
SD$133.961
TN$127.121
TX$130.36–$143.838
UT$132.891
VA$135.35–$158.792
VI$140.181
VT$134.391
WA$142.79–$160.812
WI$129.831
WV$130.571
WY$137.201

See 29435 in every payment locality

How the 29435 rate is calculated

Each of 29435’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 29435

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.15

1.15 RVUs× 1.000 GPCI

Practice expense2.78

2.78 RVUs× 1.000 GPCI

Malpractice0.24

0.24 RVUs× 1.000 GPCI

Adjusted RVUs

4.1700

Conversion factor

$33.4009

Medicare rate

$139.28

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Hawaii, Guam, HI inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,293

Code
29435
Physician work
1.15
Practice expense
2.78
Malpractice
0.24

GPCI2026.csv

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 29435 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.15× 1.0001.1500
Practice expense2.78× 1.1373.1609
Malpractice0.24× 0.5790.1390
Total RVUs4.4498
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$148.63

Office: (1.15 × 1 + 2.78 × 1.137 + 0.24 × 0.579) × $33.4009 = $148.63

Facility: (1.15 × 1 + 1.04 × 1.137 + 0.24 × 0.579) × $33.4009 = $82.55

Open 29435 in the RVU calculator

Payment rules and modifiers for 29435

The CMS indicators that decide how 29435 is paid alongside other services.

CMS payment indicators · 29435

PTB cast, below knee

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

29435 without 50 · national office

$139.28

PTB cast, below knee

29435-50 · Bilateral: 150%

$208.92

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 29435

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 29435
CodeHow it relatesOffice range, Hawaii, Guam, HI
Same family
29405Short leg cast, nonwalking castShort-leg cast application without the specified PTB design.$93.89
29425Walking cast, short legWalking short-leg cast application; distinguished by cast design.$86.66
29445Total contact cast, rigid leg castRigid total-contact leg cast application, a different cast design.$138.70

How 29435 has changed in Hawaii, Guam, HI

29435 · Office / nonfacility

$148.63

Effective 2026-10-01

The base rate is $15.42 higher than on 2025-10-01, moving from $133.21 to $148.63 (11.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $133.21changed to$148.63

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.18 changed to 1.15
    • Practice expense RVU 2.44 changed to 2.78
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $134.79changed to$133.21

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.38 changed to 2.44

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $132.59changed to$134.79

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $125.07changed to$132.59

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.08 changed to 2.38
    • Malpractice RVU 0.20 changed to 0.24
    • Work GPCI 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $121.47changed to$125.07

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.91 changed to 2.08
    • Work GPCI 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $123.11changed to$121.47

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.92 changed to 1.91
    • Malpractice RVU 0.21 changed to 0.20

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $124.51changed to$123.11

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.86 changed to 1.92
    • Work GPCI 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $128.17changed to$124.51

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.96 changed to 1.86
    • Work GPCI 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $129.67changed to$128.17

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.00 changed to 1.96

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $128.86changed to$129.67

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.98 changed to 2.00
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $127.93changed to$128.86

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.95 changed to 1.98
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $130.70changed to$127.93

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.00 changed to 1.95
    • Malpractice RVU 0.21 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $130.05changed to$130.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $125.54changed to$130.05

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.88 changed to 2.00
    • Malpractice RVU 0.22 changed to 0.21
    • Work GPCI 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $132.79changed to$125.54

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.22 changed to 1.88
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$132.79

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$148.63$82.55RVU26D
2026-07-01$148.63$82.55RVU26C
2026-04-01$148.63$82.55RVU26B
2026-01-01$148.63$82.55RVU26A
2025-10-01$133.21$87.87RVU25D
2025-07-01$133.21$87.87RVU25C
2025-04-01$133.21$87.87RVU25B
2025-01-01$133.21$87.87RVU25A
2024-10-01$134.79$89.28RVU24D
2024-07-01$134.79$89.28RVU24C
2024-04-01$134.79$89.28RVU24B
2024-03-09$134.79$89.28RVU24AR
2024-01-01$132.59$87.82RVU24A
2023-10-01$125.07$84.30RVU23D
2023-07-01$125.07$84.30RVU23C
2023-04-01$125.07$84.30RVU23B
2023-01-01$125.07$84.30RVU23A
2022-10-01$121.47$83.89RVU22D
2022-07-01$121.47$83.89RVU22C
2022-04-01$121.47$83.89RVU22B
2022-01-01$121.47$83.89RVU22A
2021-10-01$123.11$85.62RVU21D
2021-07-01$123.11$85.62RVU21C
2021-04-01$123.11$85.62RVU21B
2021-01-01$123.11$85.62RVU21A
2020-10-01$124.51$87.36RVU20D
2020-07-01$124.51$87.36RVU20C
2020-04-01$124.51$87.36RVU20B
2020-01-01$124.51$87.36RVU20A
2019-10-01$128.17$88.10RVU19D
2019-07-01$128.17$88.10RVU19C
2019-04-01$128.17$88.10RVU19B
2019-01-01$128.17$88.10RVU19A
2018-10-01$129.67$89.24RVU18D
2018-07-01$129.67$89.24RVU18C
2018-04-01$129.67$89.24RVU18B
2018-01-01$129.67$89.24RVU18AR1
2017-10-01$128.86$89.10RVU17D
2017-07-01$128.86$89.10RVU17C
2017-04-01$128.86$89.10RVU17B
2017-01-01$128.86$89.10RVU17A
2016-10-01$127.93$88.41RVU16D
2016-07-01$127.93$88.41RVU16C
2016-04-01$127.93$88.41RVU16B
2016-01-01$127.93$88.41RVU16A
2015-10-01$130.70$89.78RVU15D
2015-07-01$130.70$89.78RVU15C
2015-04-01$130.05$89.34RVU15B
2015-01-01$130.05$89.34RVU15A
2014-10-01$125.54$87.79RVU14D
2014-07-01$125.54$87.79RVU14C
2014-04-01$125.54$87.79RVU14B
2014-01-01$125.54$87.79RVU14A
2013-10-01$132.79$89.99RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 29435 for an earlier date of service

Where the Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

29435 billing questions

How is a PTB cast different from a short-leg cast?

A PTB cast is shaped to transfer load through the patellar tendon region. Use the short-leg cast code when that specific design is not applied.

Is the cast application separately reported with fracture treatment?

Not when the fracture-treatment service reported already includes cast application. Report this application only when it is separately reportable.

What documentation supports this code?

Document the treated side, indication, and application of a below-knee cast designed to bear through the patellar tendon region.

How does Medicare handle bilateral application?

CMS lists this as a bilateral procedure: modifier 50 is paid at 150%.

What happens when this is performed with another procedure?

For procedures performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction.

Can an assistant, co-surgeon, or surgical team be reported?

Assistant-at-surgery payment is restricted for this service. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 29435PPRRVU2026_Oct_nonQPP.csv, line 3,293 (RVU26D)
Geographic factors for Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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