Surgical · Wrist

Surgical osteotomy of the radius at the middle or proximal third to correct angular deformity of the forearm.

Verified May 8, 2026 · 5 sources ↓

Medicare: $718.45
Total RVUs: 21.51
Global, days: 90
Region: Wrist

Drawn from CMSAAPCEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the exact location of the osteotomy — middle third vs. proximal third of the radius — in the operative note
Document the underlying deformity or malunion with preoperative imaging correlation, including the degree of angulation measured
Describe the surgical technique: approach used, osteotomy type (opening wedge, closing wedge, dome), fixation method, and graft if applicable
Record intraoperative fluoroscopy findings and final alignment achieved before wound closure
If modifier 22 is appended, include a separate attestation paragraph quantifying the additional time, complexity, or anatomical challenges encountered

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 58 Staged or related 59 Distinct service 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 5 cited references ↓

CPT 25355 covers an osteotomy — a planned bone cut and realignment — performed at the middle or proximal third of the radius. The procedure addresses angular deformities, malunions, or other structural problems of the forearm's radius that require corrective reshaping rather than simple fixation. It is categorized under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist.

The 90-day global period means all routine follow-up care through day 90 is bundled into the surgical payment. Any E/M service during that window for an unrelated problem requires modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25. A staged or planned return to address a related issue uses modifier 58; an unplanned return for a related complication uses modifier 78; an unrelated procedure during the global uses modifier 79.

Site of service matters here: HOPD and ASC payments differ substantially (see the Site of Service comparison table). When the procedure requires significantly greater-than-typical work — complex deformity, prior hardware removal, difficult exposure — append modifier 22 and document the specific factors driving increased intraoperative time and complexity.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.27
Practice expense RVU	9.05
Malpractice RVU	2.19
Total RVU	21.51
Medicare national rate	$718.45
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	$718.45
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25355 get rejected.

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

Missing or vague operative note — 'standard approach' without specifying osteotomy level or technique triggers audit flags
Global period conflicts — E/M or minor procedure billed within the 90-day global without required modifier 24 or 79
Medical necessity not established — no preoperative imaging or documented failed conservative management in the record
Modifier 22 appended without supporting narrative explaining why the procedure exceeded typical complexity
Bilateral billing without modifier 50 or LT/RT when both forearms are treated in the same session

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What distinguishes 25355 from 25350?

25350 covers an osteotomy of the distal radius. 25355 is for the middle or proximal third. The anatomical level of the bone cut is the determining factor — confirm in the operative note and match to the correct code.

02Can 25355 be billed with hardware removal on the same day?

If prior hardware must be removed as a necessary part of the osteotomy approach, it is typically bundled. If hardware removal is a separately distinct procedure at a different site requiring additional work, append modifier 59 or XS and document the distinct nature clearly in the operative note.

03Does the 90-day global period apply if the patient is seen postoperatively by a different provider in the same group?

Yes. The global period follows the procedure regardless of which provider in the group sees the patient. Routine post-op visits by any group member are bundled. Unrelated problems billed by any group provider in that window still need modifier 24.

04When is modifier 22 appropriate for 25355?

Use modifier 22 when documented factors substantially increase surgical work — for example, severe deformity with multiple prior failed fixations, significant scar tissue, or complex hardware removal. The operative note must include a specific explanation; a generic 'procedure was difficult' statement will not support the claim.

05Is 25355 payable in an ASC setting?

Yes. CMS has established an ASC payment rate for 25355 (see the Site of Service comparison table). The HOPD rate is higher; choose the site based on clinical need and document accordingly. Payer contracts may vary — verify individual plan ASC coverage policies.

06What ICD-10 diagnoses typically support 25355?

Malunion of a radius fracture (M84.3x-), acquired deformity of the forearm (M21.x-), and post-traumatic angular deformity of the radius are the most common supporting diagnoses. The diagnosis must reflect why structural correction — not just stabilization — was required.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the osteotomy site (middle vs. proximal third), degree of preoperative angulation, surgical approach, osteotomy configuration, fixation hardware used, and intraoperative alignment achieved from dictation. This prevents the most common audit flag for 25355 — operative notes that confirm a revision was performed but fail to document the anatomical level and technique with enough specificity to support medical necessity.

See how Mira captures CPT 25355 documentation