CPT code 29435: PTB cast, below knee2026 Medicare rate & RVUs in Iowa
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.
In Iowa, Medicare pays $126.56 for 29435 in the office and $73.38 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Iowa 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. Iowa pays $126.56. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Iowa · this page$126.56
- Los Angeles, CA · California$155.16+$28.60
- Washington, DC area · District of Columbia$158.79+$32.23
- Miami, FL · Florida$155.35+$28.79
- Chicago, IL · Illinois$150.40+$23.84
- Manhattan, NY · New York$161.48+$34.92
- Alaska · Alaska$160.92+$34.36
Other areas in Iowa first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $145.13 | $81.43 |
| Merced, CACalifornia | $145.13 | $81.43 |
| Modesto, CACalifornia | $145.13 | $81.43 |
| Napa, CACalifornia | $167.29 | $90.69 |
| Oxnard, CACalifornia | $154.23 | $85.54 |
| Redding, CACalifornia | $145.13 | $81.43 |
| Rest of CaliforniaCalifornia | $145.13 | $81.43 |
| Riverside, CACalifornia | $147.71 | $84.01 |
| Sacramento, CACalifornia | $152.08 | $84.49 |
| Salinas, CACalifornia | $151.52 | $84.16 |
| San Diego, CACalifornia | $154.96 | $85.45 |
| Marin County, CACalifornia | $176.66 | $94.72 |
| San Francisco, CACalifornia | $176.39 | $94.45 |
| San Benito County, CACalifornia | $180.83 | $97.02 |
| Santa Clara County, CACalifornia | $179.71 | $95.91 |
| San Luis Obispo, CACalifornia | $149.12 | $82.93 |
| Santa Cruz, CACalifornia | $156.33 | $85.72 |
| Santa Maria, CACalifornia | $152.05 | $84.29 |
| Santa Rosa, CACalifornia | $157.89 | $86.52 |
| Stockton, CACalifornia | $145.13 | $81.43 |
| Vallejo, CACalifornia | $166.89 | $90.29 |
| Visalia, CACalifornia | $145.13 | $81.43 |
| Yuba City, CACalifornia | $145.13 | $81.43 |
| ColoradoColorado | $143.93 | $82.09 |
| ConnecticutConnecticut | $148.88 | $86.29 |
| DelawareDelaware | $137.55 | $80.13 |
| Fort Lauderdale, FLFlorida | $146.97 | $88.09 |
| Rest of FloridaFlorida | $139.23 | $83.67 |
| Atlanta, GAGeorgia | $142.49 | $83.45 |
| Rest of GeorgiaGeorgia | $130.79 | $78.95 |
| Hawaii, Guam, HIHawaii | $148.63 | $82.55 |
| IdahoIdaho | $127.63 | $74.16 |
| East St. Louis, ILIllinois | $139.98 | $86.51 |
| Rest of IllinoisIllinois | $135.72 | $82.66 |
| Suburban Chicago, ILIllinois | $148.25 | $88.56 |
| IndianaIndiana | $128.38 | $74.51 |
| KansasKansas | $126.39 | $73.85 |
| KentuckyKentucky | $128.29 | $76.63 |
| New Orleans, LALouisiana | $134.89 | $80.20 |
| Rest of LouisianaLouisiana | $128.27 | $76.83 |
| Metropolitan Boston, MAMassachusetts | $157.99 | $88.60 |
| Rest of MassachusettsMassachusetts | $143.19 | $81.99 |
| Baltimore area, MDMaryland | $148.57 | $86.21 |
| Rest of MarylandMaryland | $140.12 | $81.31 |
| Rest of MaineMaine | $128.82 | $75.36 |
| Southern Maine, MEMaine | $135.49 | $77.89 |
| Detroit, MIMichigan | $141.53 | $85.45 |
| Rest of MichiganMichigan | $132.24 | $79.18 |
| MinnesotaMinnesota | $136.33 | $76.53 |
| Metropolitan Kansas City, MOMissouri | $133.43 | $78.86 |
| Metropolitan St. Louis, MOMissouri | $134.84 | $79.51 |
| Rest of MissouriMissouri | $126.26 | $76.16 |
| MississippiMississippi | $124.28 | $74.24 |
| MontanaMontana | $139.27 | $81.15 |
| North CarolinaNorth Carolina | $130.17 | $75.94 |
| North DakotaNorth Dakota | $134.52 | $76.40 |
| NebraskaNebraska | $127.15 | $73.50 |
| New HampshireNew Hampshire | $142.09 | $81.59 |
| Northern New JerseyNew Jersey | $157.10 | $89.69 |
| Rest of New JerseyNew Jersey | $150.14 | $86.67 |
| New MexicoNew Mexico | $133.19 | $79.89 |
| NevadaNevada | $138.04 | $79.86 |
| NYC suburbs and Long Island, NYNew York | $166.16 | $97.06 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $151.51 | $87.88 |
| Queens, NYNew York | $162.18 | $93.49 |
| Rest of New YorkNew York | $132.26 | $77.05 |
| OhioOhio | $131.27 | $78.21 |
| OklahomaOklahoma | $127.56 | $75.66 |
| Portland, OROregon | $148.15 | $83.58 |
| Rest of OregonOregon | $136.53 | $78.64 |
| Metropolitan Philadelphia, PAPennsylvania | $145.33 | $84.83 |
| Rest of PennsylvaniaPennsylvania | $131.23 | $77.87 |
| Puerto RicoPuerto Rico | $140.18 | $81.43 |
| Rhode IslandRhode Island | $142.21 | $82.17 |
| South CarolinaSouth Carolina | $131.02 | $77.32 |
| South DakotaSouth Dakota | $133.96 | $75.84 |
| TennesseeTennessee | $127.12 | $74.29 |
| Austin, TXTexas | $143.83 | $82.34 |
| Beaumont, TXTexas | $130.36 | $77.47 |
| Brazoria, TXTexas | $136.99 | $79.40 |
| Dallas, TXTexas | $138.12 | $80.23 |
| Fort Worth, TXTexas | $137.29 | $79.99 |
| Galveston, TXTexas | $137.56 | $79.85 |
| Houston, TXTexas | $141.95 | $84.24 |
| Rest of TexasTexas | $133.77 | $78.62 |
| UtahUtah | $132.89 | $78.26 |
| VirginiaVirginia | $135.35 | $78.22 |
| Virgin Islands, VIUnited States Virgin Islands | $140.18 | $81.43 |
| VermontVermont | $134.39 | $76.86 |
| Rest of WashingtonWashington | $142.79 | $81.59 |
| King County, WAWashington | $160.81 | $89.50 |
| WisconsinWisconsin | $129.83 | $74.16 |
| West VirginiaWest Virginia | $130.57 | $80.07 |
| WyomingWyoming | $137.20 | $79.08 |
29435 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $160.92 | 1 |
| AL | $124.20 | 1 |
| AR | $122.30 | 1 |
| AZ | $135.25 | 1 |
| CA | $145.13–$180.83 | 29 |
| CO | $143.93 | 1 |
| CT | $148.88 | 1 |
| DC | $158.79 | 1 |
| DE | $137.55 | 1 |
| FL | $139.23–$155.35 | 3 |
| GA | $130.79–$142.49 | 2 |
| GU | $148.63 | 1 |
| HI | $148.63 | 1 |
| IA | $126.56 | 1 |
| ID | $127.63 | 1 |
| IL | $135.72–$150.40 | 4 |
| IN | $128.38 | 1 |
| KS | $126.39 | 1 |
| KY | $128.29 | 1 |
| LA | $128.27–$134.89 | 2 |
| MA | $143.19–$157.99 | 2 |
| MD | $140.12–$158.79 | 3 |
| ME | $128.82–$135.49 | 2 |
| MI | $132.24–$141.53 | 2 |
| MN | $136.33 | 1 |
| MO | $126.26–$134.84 | 3 |
| MS | $124.28 | 1 |
| MT | $139.27 | 1 |
| NC | $130.17 | 1 |
| ND | $134.52 | 1 |
| NE | $127.15 | 1 |
| NH | $142.09 | 1 |
| NJ | $150.14–$157.10 | 2 |
| NM | $133.19 | 1 |
| NV | $138.04 | 1 |
| NY | $132.26–$166.16 | 5 |
| OH | $131.27 | 1 |
| OK | $127.56 | 1 |
| OR | $136.53–$148.15 | 2 |
| PA | $131.23–$145.33 | 2 |
| PR | $140.18 | 1 |
| RI | $142.21 | 1 |
| SC | $131.02 | 1 |
| SD | $133.96 | 1 |
| TN | $127.12 | 1 |
| TX | $130.36–$143.83 | 8 |
| UT | $132.89 | 1 |
| VA | $135.35–$158.79 | 2 |
| VI | $140.18 | 1 |
| VT | $134.39 | 1 |
| WA | $142.79–$160.81 | 2 |
| WI | $129.83 | 1 |
| WV | $130.57 | 1 |
| WY | $137.20 | 1 |
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
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 Iowa 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
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.15 | × 1.000 | 1.1500 |
| Practice expense | 2.78 | × 0.915 | 2.5437 |
| Malpractice | 0.24 | × 0.397 | 0.0953 |
| Total RVUs | 3.7890 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Iowa$126.56
Office: (1.15 × 1 + 2.78 × 0.915 + 0.24 × 0.397) × $33.4009 = $126.56
Facility: (1.15 × 1 + 1.04 × 0.915 + 0.24 × 0.397) × $33.4009 = $73.38
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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).
How 29435 has changed in Iowa
29435 · Office / nonfacility
$126.56
Effective 2026-10-01
The base rate is $12.78 higher than on 2025-10-01, moving from $113.78 to $126.56 (11.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$113.78changed to$126.56
- 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 0.913 changed to 0.915
- Malpractice GPCI 0.457 changed to 0.397
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$115.26changed to$113.78
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.38 changed to 2.44
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$113.38changed to$115.26
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$107.12changed to$113.38
- 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
- Practice expense GPCI 0.910 changed to 0.913
- Malpractice GPCI 0.441 changed to 0.457
January 1, 2023
RVU23A
$103.73changed to$107.12
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.91 changed to 2.08
- Practice expense GPCI 0.907 changed to 0.910
- Malpractice GPCI 0.425 changed to 0.441
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$105.05changed to$103.73
- 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.
January 1, 2021
RVU21A
$106.68changed to$105.05
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.86 changed to 1.92
- Malpractice GPCI 0.424 changed to 0.425
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$109.79changed to$106.68
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.96 changed to 1.86
- Malpractice GPCI 0.423 changed to 0.424
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$110.98changed to$109.79
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.00 changed to 1.96
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$109.73changed to$110.98
- 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
- Practice expense GPCI 0.902 changed to 0.907
- Malpractice GPCI 0.458 changed to 0.423
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$108.34changed to$109.73
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.95 changed to 1.98
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 0.493 changed to 0.458
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$110.51changed to$108.34
- 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.
July 1, 2015
RVU15C
$109.96changed to$110.51
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$106.09changed to$109.96
- 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
- Practice expense GPCI 0.892 changed to 0.896
- Malpractice GPCI 0.475 changed to 0.493
Held through RVU15B.
January 1, 2014
RVU14A
$110.71changed to$106.09
- 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
- Practice expense GPCI 0.887 changed to 0.892
- Malpractice GPCI 0.456 changed to 0.475
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $110.71
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $126.56 | $73.38 | RVU26D |
| 2026-07-01 | $126.56 | $73.38 | RVU26C |
| 2026-04-01 | $126.56 | $73.38 | RVU26B |
| 2026-01-01 | $126.56 | $73.38 | RVU26A |
| 2025-10-01 | $113.78 | $77.75 | RVU25D |
| 2025-07-01 | $113.78 | $77.75 | RVU25C |
| 2025-04-01 | $113.78 | $77.75 | RVU25B |
| 2025-01-01 | $113.78 | $77.75 | RVU25A |
| 2024-10-01 | $115.26 | $79.10 | RVU24D |
| 2024-07-01 | $115.26 | $79.10 | RVU24C |
| 2024-04-01 | $115.26 | $79.10 | RVU24B |
| 2024-03-09 | $115.26 | $79.10 | RVU24AR |
| 2024-01-01 | $113.38 | $77.81 | RVU24A |
| 2023-10-01 | $107.12 | $74.74 | RVU23D |
| 2023-07-01 | $107.12 | $74.74 | RVU23C |
| 2023-04-01 | $107.12 | $74.74 | RVU23B |
| 2023-01-01 | $107.12 | $74.74 | RVU23A |
| 2022-10-01 | $103.73 | $73.91 | RVU22D |
| 2022-07-01 | $103.73 | $73.91 | RVU22C |
| 2022-04-01 | $103.73 | $73.91 | RVU22B |
| 2022-01-01 | $103.73 | $73.91 | RVU22A |
| 2021-10-01 | $105.05 | $75.30 | RVU21D |
| 2021-07-01 | $105.05 | $75.30 | RVU21C |
| 2021-04-01 | $105.05 | $75.30 | RVU21B |
| 2021-01-01 | $105.05 | $75.30 | RVU21A |
| 2020-10-01 | $106.68 | $77.22 | RVU20D |
| 2020-07-01 | $106.68 | $77.22 | RVU20C |
| 2020-04-01 | $106.68 | $77.22 | RVU20B |
| 2020-01-01 | $106.68 | $77.22 | RVU20A |
| 2019-10-01 | $109.79 | $78.09 | RVU19D |
| 2019-07-01 | $109.79 | $78.09 | RVU19C |
| 2019-04-01 | $109.79 | $78.09 | RVU19B |
| 2019-01-01 | $109.79 | $78.09 | RVU19A |
| 2018-10-01 | $110.98 | $78.98 | RVU18D |
| 2018-07-01 | $110.98 | $78.98 | RVU18C |
| 2018-04-01 | $110.98 | $78.98 | RVU18B |
| 2018-01-01 | $110.98 | $78.98 | RVU18AR1 |
| 2017-10-01 | $109.73 | $78.66 | RVU17D |
| 2017-07-01 | $109.73 | $78.66 | RVU17C |
| 2017-04-01 | $109.73 | $78.66 | RVU17B |
| 2017-01-01 | $109.73 | $78.66 | RVU17A |
| 2016-10-01 | $108.34 | $77.86 | RVU16D |
| 2016-07-01 | $108.34 | $77.86 | RVU16C |
| 2016-04-01 | $108.34 | $77.86 | RVU16B |
| 2016-01-01 | $108.34 | $77.86 | RVU16A |
| 2015-10-01 | $110.51 | $78.96 | RVU15D |
| 2015-07-01 | $110.51 | $78.96 | RVU15C |
| 2015-04-01 | $109.96 | $78.57 | RVU15B |
| 2015-01-01 | $109.96 | $78.57 | RVU15A |
| 2014-10-01 | $106.09 | $77.01 | RVU14D |
| 2014-07-01 | $106.09 | $77.01 | RVU14C |
| 2014-04-01 | $106.09 | $77.01 | RVU14B |
| 2014-01-01 | $106.09 | $77.01 | RVU14A |
| 2013-10-01 | $110.71 | $77.82 | RVU13D |
| 2013-07-01 | $110.71 | $77.82 | RVU13C |
| 2013-04-01 | $110.71 | $77.82 | RVU13B |
| 2013-01-01 | $110.71 | $77.82 | RVU13AR |
Where the Iowa rate applies
Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.
- Ackley
- Ackworth
- Adair
- Adel
- Afton
- Agency
- Ainsworth
- Akron
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
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