Surgical · Wrist

Surgical reshaping or realignment of the ulna, including internal fixation when performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $609.90
Work RVU: 8.52
Global, days: 90
Region: Wrist

Drawn from CMSGoAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify osteotomy type by name (e.g., opening wedge, closing wedge, dome, oblique)
Identify anatomic site on the ulna — proximal, mid-shaft, or distal
Document internal fixation method and hardware used, even though it is bundled into 25360
Record the indication — malunion, deformity type, degree of angulation or rotation corrected
Include pre-op imaging findings (X-ray or CT) that confirm structural abnormality requiring osteotomy
Note intraoperative fluoroscopy use; if billed separately, confirm it is not integral per NCCI Chapter 4 rules

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25360 covers an osteotomy of the ulna — cutting and repositioning the bone to correct angular deformity, rotational malalignment, or length discrepancy. Internal fixation, when used to stabilize the osteotomy site, is included in the code and not separately billable. This is a 090-day global procedure, so all related post-op care through day 90 is bundled into the surgical payment.

Common indications include ulnar malunion after prior fracture, Madelung deformity correction, and post-traumatic angular deformity. The operative note must specify the type of osteotomy performed (e.g., opening wedge, closing wedge, dome), the site on the ulna (proximal, mid-shaft, distal), and whether fixation hardware was applied. Vague notes like 'ulna corrected' without technique detail are a frequent audit flag.

If a radial osteotomy is performed at the same operative session, 25350 or 25355 may be reported separately with modifier 51 — but confirm NCCI PTP edits before billing the pair. Procedures performed bilaterally require modifiers LT and RT on separate line items. An E/M on the day of surgery is not separately billable unless it is a significant, separately identifiable service unrelated to the decision to operate, in which case modifier 57 or 25 applies depending on global period classification.

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 (8.52) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.26) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.52
Practice expense RVU	8.07
Malpractice RVU	1.67
Total RVU	18.26
Medicare national rate	$609.90
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	$609.90
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,074.44

Common denial reasons

The recurring reasons claims for CPT 25360 get rejected.

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

Operative note lacks osteotomy technique detail — 'ulna corrected' without named approach triggers medical necessity denials
Internal fixation billed separately with 25360 — fixation is bundled and will be denied
Missing or misapplied laterality modifier when bilateral procedures are performed on the same date
E/M billed same-day without modifier 57 or 25, triggering global package bundling edits
Unrelated same-day forearm procedure not appended with modifier 59 or XS, causing NCCI PTP edit denial

Frequently asked questions

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

01Is internal fixation separately billable when performed with CPT 25360?

No. Internal fixation is included in 25360. Billing a separate fixation code alongside it will be denied as bundled.

02Can 25360 and a radial osteotomy code be billed together on the same date?

Yes, if both ulnar and radial osteotomies are performed as distinct procedures, bill the appropriate radial osteotomy code (25350 or 25355) with modifier 51 appended. Verify the NCCI PTP edit table first — many private payers follow those edits and may require modifier 59 or XS to bypass bundling.

03What modifier is required for bilateral ulnar osteotomies?

Report 25360 on two separate line items with modifier LT on one and RT on the other. Do not use modifier 50 as a single-line bilateral indicator for this procedure without confirming payer preference.

04What does the 090-day global period cover for 25360?

The 90-day global covers the surgery, the day-before pre-op visit, and all routine post-op care through day 90 — including wound checks, dressing changes, and hardware monitoring. Any unrelated service in that window needs modifier 24 on the E/M or modifier 79 on an unrelated procedure.

05Can an E/M be billed the same day as 25360?

Only if it is a significant, separately identifiable service unrelated to the decision to perform the osteotomy. Append modifier 57 when the E/M was the decision-making visit for a major procedure, or modifier 25 if it is a minor procedure context. The fact that the patient is new does not by itself justify a same-day E/M.

06Is fluoroscopy separately reportable during CPT 25360?

It depends on whether fluoroscopy is considered integral to the procedure for a given payer. Per NCCI Chapter 4, fluoroscopy performed during a surgical procedure may not be separately reportable if it is integral to that procedure. Check your payer's policy and the NCCI PTP edit table before billing a fluoroscopy code alongside 25360.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the osteotomy type (opening wedge, closing wedge, dome), anatomic site on the ulna, degree of deformity corrected, fixation hardware applied, and fluoroscopy use from the surgeon's dictation. This prevents the most common denial trigger for 25360 — operative notes that describe the outcome without documenting the named surgical technique.

See how Mira captures CPT 25360 documentation