Surgical · Wrist

Osteotomy of the distal third of the radius, involving surgical cutting and repositioning of the bone at the wrist end of the forearm.

Verified May 8, 2026 · 6 sources ↓

Medicare: $626.93
Work RVU: 8.86
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact location: distal third of the radius — vague anatomic references flag audits
Document the indication: malunion, deformity, angulation, or failed conservative management with clinical measurements (e.g., radial inclination, volar tilt angles pre- and post-op)
Operative note must name the osteotomy technique and fixation method used (e.g., opening wedge with plate fixation)
If modifier 22 is used, include a separate written statement quantifying the additional work — intraoperative complexity, increased time, or anatomic difficulty
If a same-day E/M was billed with modifier 57, document that the visit was the decision point for surgery
If co-surgeon (modifier 62) is billed, each surgeon must document their distinct portion of the procedure separately

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25350 describes an osteotomy of the radius at the distal third — a procedure where the surgeon cuts the radius near the wrist to correct angulation, malunion, or deformity. It is most commonly performed after malunited distal radius fractures where conservative management has failed and the patient has persistent pain, deformity, or functional limitation. The surgeon corrects the alignment, often with internal fixation, to restore normal biomechanics at the wrist.

This code is site-specific: 25350 covers the distal third only. The middle third has its own code (25355), and if both radius and ulna osteotomies are performed at the same session, report 25365 instead — billing 25350 and 25360 together will be denied when both sites match, as AAPC guidance confirms the combo code applies when osteotomies are the same type performed at the same session.

The 90-day global period means the surgery date, the day-before visit, and all routine post-op management through day 90 are bundled. Any E/M tied to the decision for surgery on the same day requires modifier 57, not modifier 25 — 25350's major global status disqualifies modifier 25 for that purpose.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.77) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.86
Practice expense RVU	8.19
Malpractice RVU	1.72
Total RVU	18.77
Medicare national rate	$626.93
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$626.93
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,756.45

Common denial reasons

The recurring reasons claims for CPT 25350 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billing 25350 and 25360 together instead of 25365 when both radius and ulna osteotomies are performed in the same session
Modifier 25 appended to same-day E/M instead of modifier 57 — payers reject modifier 25 on E/M services paired with major (90-day) global procedures
Insufficient documentation of distal third location — operative notes that reference only 'distal radius' without specifying the third can be flagged as non-specific
Missing or inadequate support for modifier 22 — increased complexity claims denied without a separate, detailed written justification
Unbundling of fixation or bone graft services that payers consider inclusive to the osteotomy at the same site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01When should I use 25365 instead of 25350?

Use 25365 when osteotomies are performed on both the radius and ulna at the same operative session and are the same type of osteotomy. Billing 25350 and 25360 separately in that scenario will be denied — 25365 is the correct combo code per AAPC orthopedic coding guidance.

02Can I bill a same-day E/M with 25350, and which modifier applies?

Yes, but use modifier 57, not modifier 25. Because 25350 carries a 90-day global, the associated E/M must reflect the decision for surgery. Modifier 25 is reserved for minor global (0- or 10-day) procedures.

03Does the 90-day global period cover post-op imaging and hardware checks?

Routine post-op visits, dressing changes, and clinical assessments through day 90 are bundled. Separately payable post-op imaging (e.g., X-rays) may be billed, but any E/M for a related issue during the global requires modifier 24 to bypass the global bundle.

04Is 25350 bilateral? Can modifier 50 apply?

Bilateral distal radius osteotomy is clinically uncommon but not impossible. If performed on both sides in the same session, modifier 50 is appropriate. Document both sides explicitly in the operative note.

05What ICD-10 diagnoses are most commonly paired with 25350?

Malunion of distal radius fracture (M84.83x series), acquired deformity of the forearm (M21.8x), and post-traumatic wrist pain with documented structural abnormality are the typical drivers. Diagnosis must match the documented indication for osteotomy — a pain-only code without structural finding invites medical necessity denial.

06Can I separately bill bone graft harvest with 25350?

It depends on the graft source and payer. Autograft from a separate incision site may be separately reportable; iliac crest harvest has its own codes. However, many payers bundle local bone graft into the osteotomy itself. Check NCCI edits and payer-specific policies before appending a graft code.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific anatomic site (distal third of radius), the osteotomy technique, fixation method, and the clinical indication driving the correction — including pre-op deformity measurements when dictated. It also flags when both radius and ulna osteotomies are performed in the same session, prompting review of 25365 over separate codes. This prevents the most common denial pattern for this code: site-level unbundling and missing anatomic specificity in the operative note.

See how Mira captures CPT 25350 documentation