CPT code 29435: PTB cast, below knee2026 Medicare rate & RVUs in Washington
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.
Medicare pays $142.79–$160.81 for 29435 in the office in Washington, from Rest of Washington to King County, WA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 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.
Where 29435 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | $160.81 | $89.50 |
| Rest of Washington | $142.79 | $81.59 |
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.
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).
29435 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 29405Short leg castNonwalking cast
- Use 29435 for a below-knee cast designed to transfer weight through the patellar tendon region. Code 29405 describes short-leg cast application without that specific PTB design.
- 29425Walking castShort leg
- Code 29425 is for a walking short-leg cast. Choose 29435 when the applied cast has the PTB design, rather than selecting by weight-bearing status alone.
- 29440Cast walkerAdded to prior cast
- Code 29440 describes adding a walker to a previously applied cast. Code 29435 reports application of the PTB cast itself.
- 29445Total contact castRigid leg cast
- Code 29445 is for a rigid total-contact leg cast. It is not the PTB application code unless the cast applied is specifically the PTB design.
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
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