Surgical shortening of the radius or ulna via resection of a bone segment, with fixation of the remaining ends.

Verified May 8, 2026 · 8 sources ↓

Medicare: $704.76
Total RVUs: 21.1
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify which bone is being shortened — radius or ulna — in both the operative note and the indication section; ambiguous notes are an audit flag.
Preoperative imaging (X-ray, CT, or MRI) documenting the degree of length discrepancy or impaction that justifies surgical shortening.
Intraoperative documentation of the measured length of bone segment resected and the fixation method used (plate type, screw count).
Diagnosis clearly linking the length discrepancy or structural deformity to the clinical indication — ulnar impaction, malunion, congenital anomaly, or DRUJ instability.
Failed or contraindicated conservative management documented in the chart prior to surgical authorization.
Laterality recorded in the operative note and on the claim — required when billing with LT or RT modifier.

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 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 25390 covers osteoplasty of a single forearm bone — either the radius or ulna — performed to correct length discrepancy through resection of a bone segment. The surgeon exposes the target bone, excises a measured section of the shaft, aligns the cut ends, and secures them with internal fixation (typically plate and screws). The procedure addresses conditions including ulnar impaction syndrome, post-traumatic malunion, congenital limb length discrepancy, and distal radioulnar joint (DRUJ) dysfunction.

Ulnar shortening osteotomy is the most common clinical application — used when the ulna is relatively long compared to the radius, loading the triangular fibrocartilage complex (TFCC) and causing ulnar-sided wrist pain. The amount of bone resected is calculated preoperatively from weight-bearing radiographs. Fixation stability and bone contact quality directly affect union rates and are relevant to medical necessity documentation.

This is a 90-day global procedure. All routine postoperative visits, cast changes, and hardware monitoring through day 90 are bundled into the fee. Separate billing for related E&M visits in that window requires modifier 24. If the contralateral forearm bone is also shortened at the same session, report 25392 instead — 25390 is strictly single-bone.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.43
Practice expense RVU	8.67
Malpractice RVU	2
Total RVU	21.1
Medicare national rate	$704.76
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	$704.76
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,769.82

Common denial reasons

The recurring reasons claims for CPT 25390 get rejected.

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

Wrong code selected when both radius and ulna are shortened in the same session — use 25392, not 25390 twice.
Lack of preoperative imaging or absent documentation of clinical indication supporting bone length correction.
Related E&M visit billed during the 90-day global period without modifier 24, resulting in automatic bundling denial.
Laterality modifier missing on the claim when payer requires LT or RT for unilateral procedures.
Medical necessity denied when documentation does not quantify the length discrepancy or fails to show failed conservative treatment.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 25390 and 25392?

25390 is for shortening a single forearm bone (radius OR ulna). 25392 covers shortening of both the radius AND ulna in the same operative session. Billing 25390 twice for a dual-bone procedure is incorrect and will trigger an NCCI edit.

02Can I bill 25390 and 25391 together if I shorten one bone and lengthen the other?

Potentially yes, if the clinical scenario genuinely requires simultaneous shortening of one bone and lengthening of the other, and the procedures are distinct. Append modifier 59 to the secondary code and ensure your operative note documents each procedure as a separate, distinct service with separate incisions or anatomic sites.

03What modifier applies if the procedure was significantly more complex than usual — for example, due to prior hardware or severe deformity?

Use modifier 22. You must attach a cover letter quantifying the additional time and work, and the operative note must describe the specific complicating factors (e.g., removal of prior implants, severe scarring, atypical anatomy). Without that documentation, payers routinely deny the upcharge.

04Is 25390 typically performed in an ASC or hospital outpatient setting?

Both are common sites of service. The procedure carries a 90-day global period regardless of setting. See the site-of-service comparison on this page for the HOPD vs. ASC facility payment difference, which is substantial and relevant to site selection discussions.

05What ICD-10 diagnoses most commonly support 25390?

Ulnar impaction syndrome, post-traumatic malunion of the radius or ulna, congenital limb length discrepancy of the forearm, and DRUJ instability or arthrosis are the most defensible indications. The diagnosis code must map logically to the specific bone being shortened — a radius shortening billed against a ulnar impaction diagnosis will invite scrutiny.

06Does the 90-day global period include management of hardware complications?

Routine post-op visits are bundled through day 90. An unplanned return to the OR for a complication directly related to the original fixation — such as hardware failure or wound dehiscence requiring surgical intervention — bills with modifier 78. An unrelated procedure in that same window uses modifier 79.

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 specific bone shortened (radius vs. ulna), the measured segment length resected, fixation hardware used, and the clinical indication driving the procedure — from dictation in real time. This prevents the most common audit flag for 25390: operative notes that don't document which bone was operated on or fail to quantify the resection, both of which trigger medical necessity reviews and NCCI scrutiny.

See how Mira captures CPT 25390 documentation