Soft tissue repair · Wrist

25365

Osteotomy of both the radius and ulna performed during the same operative session to correct forearm deformity or malalignment.

Verified May 8, 2026 · 6 sources ↓

Medicare
$851.05
Total RVUs
25.48
Global, days
90
Region
Wrist
Drawn from CMSAAPCEbhmcMdclarityAMA

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

  • Operative note must confirm osteotomy was performed on both the radius and ulna — not just one bone — during the same session.
  • Specify the anatomic level of each osteotomy (distal, middle, or proximal third) for each bone separately.
  • Document the clinical indication: angular deformity, rotational malunion, post-traumatic malalignment, or revision of prior forearm surgery with specific findings.
  • Record fixation method used (plate and screws, intramedullary device, external fixation, or cast immobilization alone) and implant details if hardware placed.
  • Include pre-operative imaging findings (X-ray, CT) establishing the deformity and supporting surgical necessity.
  • If modifier 22 is appended, document specific factors increasing complexity — scar tissue, prior hardware removal, unusual anatomy — with estimated additional time.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25365 covers a surgical osteotomy — a controlled bone cut — performed on both the radius and ulna in a single operative encounter. The procedure addresses angular deformity, rotational malalignment, or failed prior forearm surgery requiring bony correction of both bones. It falls under the Repair, Revision, and/or Reconstruction section of forearm and wrist CPT codes.

The 90-day global period means all routine post-op care through day 90 is bundled — no separate E/M visits for wound checks, cast changes, or radiograph reviews tied to the osteotomy. Services unrelated to the forearm correction billed in that window require modifier 24. If a decision for surgery was made at a same-day E/M visit prior to scheduling, append modifier 57 to that E/M.

Close neighbors in the code family clarify when 25365 applies versus alternatives: 25360 covers ulna osteotomy only; 25350 and 25355 address radius osteotomy alone at different levels; 25392 involves osteoplasty with shortening of both bones. If only one bone is cut, 25365 does not apply — use the single-bone code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU12.59
Practice expense RVU10.21
Malpractice RVU2.68
Total RVU25.48
Medicare national rate$851.05
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$851.05
HOPD (APC 5115)
Hospital outpatient department
$13,116.76
ASC (PI A2)
Ambulatory surgical center (freestanding)
$6,804.43

Common denial reasons

The recurring reasons claims for CPT 25365 get rejected.

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

  • Single-bone documentation billed as dual-bone osteotomy — operative note describes only radius or only ulna cut, contradicting 25365.
  • Wrong code selected when only shortening osteoplasty was performed — that maps to 25392, not 25365.
  • Routine post-op E/M visits billed without modifier 24 during the 90-day global period.
  • Missing or vague surgical indication — payers deny when the note lacks imaging-corroborated deformity or a clear clinical rationale for correcting both bones.
  • Laterality not specified when payer requires LT or RT modifier for facility-side claims, triggering front-end edits.

Frequently asked questions

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

01When should I use 25365 versus 25360 or 25350/25355?
Use 25365 only when osteotomies are performed on both the radius and ulna in the same session. If only the ulna is cut, bill 25360. If only the radius is cut, use 25350 (distal third) or 25355 (middle or proximal third). Billing 25365 when the note documents a single bone is a misrepresentation and a common audit target.
02Does 25365 require an assistant surgeon, and how do I bill that?
Per EBHMC Hand CPT reference, 25365 does allow assistant surgeon billing. The assistant reports the same CPT with modifier 80 (or AS if a PA/NP). Both surgeons' operative participation must be individually documented.
03Can I bill a same-day E/M with 25365?
Yes, but with the right modifier. If a significant, separately identifiable evaluation occurred beyond the pre-procedure assessment, append modifier 25 to the E/M. If the E/M was the visit at which you made the decision to perform surgery, use modifier 57 on the E/M instead.
04What is the global period for 25365, and what does it bundle?
25365 carries a 90-day global period. That covers the day-before visit, the surgery, and all routine post-op care through day 90 — including wound checks, cast changes, and X-ray interpretations tied to the osteotomy. Unrelated services in that window require modifier 24 (E/M) or modifier 79 (unrelated procedure).
05How does site of service affect reimbursement for 25365?
HOPD and ASC payments differ substantially for this code — see the Site of Service comparison table on this page. The physician professional fee is paid at the lower facility rate in both settings; the difference lands on the facility side. If your practice owns the ASC, that spread is worth modeling before scheduling.
06When is modifier 22 appropriate for 25365?
Append modifier 22 when documented intraoperative findings — dense scar from prior surgery, hardware removal, severely abnormal anatomy — required substantially more work than a standard dual osteotomy. The operative note must quantify added complexity; vague statements of difficulty won't hold up on appeal.
07Should I use modifier 50 or LT/RT for bilateral forearm osteotomies?
Bilateral forearm osteotomy (both arms) is exceedingly rare but would use modifier 50 on the physician claim. For facility and most MAC claims, LT and RT on separate line items is preferred. Confirm your specific payer's bilateral billing policy — some require 50, others reject it in favor of LT/RT lines.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    aapc.com
    https://www.aapc.com/codes/cpt-codes/25365
  3. 03
    ebhmc.com
    https://ebhmc.com/cpt/
  4. 04
    mdclarity.com
    https://www.mdclarity.com/cpt-code/25365
  5. 05
    ama-assn.org
    https://www.ama-assn.org/system/files/reporting-CPT-modifier-25.pdf
  6. 06
    eatonhand.com
    http://www.eatonhand.com/coding/koml4.htm

Mira AI Scribe

Mira's AI scribe captures the osteotomy level for each bone separately (radius and ulna), the fixation construct, the deformity type and degrees of correction documented intraoperatively, and whether prior hardware was removed during the same session. This prevents the most common audit flag for 25365: an operative note that describes work on only one forearm bone while the claim asserts a dual osteotomy.

See how Mira captures CPT 25365 documentation

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