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Official Description

Application, cast; shoulder to hand (long arm)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 29065 involves the application of a long arm cast, which is a type of immobilization device used to support and protect the arm from the shoulder or mid-humerus down to the hand. This procedure is essential for treating various injuries, particularly those affecting the distal humerus, elbow, and proximal to middle forearm regions. The casting process begins with the application of a stockinette, which serves as a protective layer over the skin. Following this, padding is added to provide cushioning and prevent skin irritation. The next step involves the use of a plaster or fiberglass roll, which is first immersed in water to activate its setting properties. After saturating the material, excess water is gently squeezed out to ensure it is not overly wet, which could lead to complications. The saturated plaster or fiberglass is then carefully wrapped around the arm, typically starting from the distal (far) end and moving towards the proximal (near) end. This technique allows for a snug fit that conforms to the contours of the arm. The final step in the application process involves smoothing and molding the cast to ensure comfort and effectiveness. The long arm cast is specifically designed to immobilize fractures and dislocations in the distal humerus and elbow, as well as fractures in the middle to proximal forearm, thereby facilitating proper healing and recovery.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The application of a long arm cast, as described by CPT® Code 29065, is indicated for several specific conditions and injuries that require immobilization of the arm. These indications include:

  • Distal Humeral Fractures - Fractures occurring at the lower end of the humerus, which may require stabilization to promote healing.
  • Elbow Fractures and Dislocations - Injuries involving the elbow joint that necessitate immobilization to prevent further injury and allow for proper recovery.
  • Middle to Proximal Forearm Fractures - Fractures located in the forearm region that require support and immobilization to ensure alignment and healing.

2. Procedure

The procedure for applying a long arm cast involves several detailed steps to ensure proper immobilization and support of the arm. These steps include:

  • Step 1: Preparation of the Area - The first step involves preparing the arm for casting. A stockinette is applied over the area to be casted, which serves as a protective layer against the cast material. This is followed by the application of padding over the stockinette to provide additional cushioning and prevent skin irritation during the casting process.
  • Step 2: Preparation of the Casting Material - A plaster or fiberglass roll is then taken and immersed in water to activate its setting properties. It is crucial to ensure that the material is fully saturated, as this will allow it to harden properly once applied. After immersion, excess water is gently squeezed out to avoid an overly wet application that could lead to complications.
  • Step 3: Application of the Cast - The saturated plaster or fiberglass is carefully wrapped around the arm, typically starting from the distal aspect (the hand) and moving towards the proximal aspect (the shoulder or mid-humerus). This technique ensures that the cast fits snugly and conforms to the natural contours of the arm.
  • Step 4: Molding and Smoothing - Once the cast is in place, the final step involves smoothing and molding the plaster or fiberglass to ensure comfort and effectiveness. This step is essential to create a well-fitted cast that immobilizes the arm while allowing for some degree of comfort during the healing process.

3. Post-Procedure

After the application of the long arm cast, several post-procedure considerations are important for patient care and recovery. The cast should be monitored for any signs of complications, such as excessive swelling, pain, or skin irritation. Patients are typically advised to keep the cast dry and avoid submerging it in water to maintain its integrity. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the cast. Additionally, patients may receive instructions on how to manage discomfort and maintain mobility in the unaffected areas of the arm.

Short Descr APPLICATION OF LONG ARM CAST
Medium Descr APPLICATION CAST SHOULDER HAND LONG ARM
Long Descr Application, cast; shoulder to hand (long arm)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6B - Minor procedures - musculoskeletal
MUE 1
CCS Clinical Classification 214 - Traction, splints, and other wound care
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
F4 Left hand, fifth digit
GC This service has been performed in part by a resident under the direction of a teaching physician
GO Services delivered under an outpatient occupational therapy plan of care
GP Services delivered under an outpatient physical therapy plan of care
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
KX Requirements specified in the medical policy have been met
SA Nurse practitioner rendering service in collaboration with a physician
TL Early intervention/individualized family service plan (ifsp)
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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