Billing code 29435: PTB castMedicare rate & RVUs

Medicare pays $139.28 for 29435 nationally in the office and $81.16 in a hospital or facility. Local office rates run $122.30–$180.83.

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

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

29435 rates by state

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

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.

Payment rules and modifiers for 29435

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

What modifiers do to the payment

When to use modifier 50

29435 compared with similar codes

How to choose

29405Short leg 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 cast

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 walker

Code 29440 describes adding a walker to a previously applied cast. Code 29435 reports application of the PTB cast itself.

29445Total contact 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.

Codes related to 29435

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

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

Open CMS sourceHow we calculate rates