Surgical · Wrist

Osteoplasty of the radius or ulna with lengthening using autograft harvested from the patient.

Verified May 8, 2026 · 6 sources ↓

Medicare: $919.19
Total RVUs: 27.52
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which bone was lengthened — radius or ulna — and the side (left/right).
Document the indication: congenital shortening, post-traumatic deformity, growth arrest, or other etiology.
Confirm autograft harvest site, quantity harvested, and graft preparation technique; if allograft was used instead, state that explicitly and explain clinical rationale.
Record the osteotomy technique, method of fixation (plate, external fixator, IM device), and final bone length achieved.
If modifier 22 is appended, operative note must quantify the additional work — unusual anatomy, prior hardware, revision field, or extended operative time.
If billing a same-day E/M with modifier 57, document that the surgical decision was made at that encounter and that the service was distinct from pre-procedure assessment.

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25391 covers a forearm osteoplasty in which the surgeon cuts the radius or ulna, then interposes an autogenous bone graft to increase the bone's length. The procedure addresses conditions including congenital shortening, post-traumatic deformity, and length discrepancies following prior fracture malunion or growth arrest. Because the code specifically describes autograft harvest and interposition, the graft harvest is considered bundled — do not separately report a graft harvest code.

When an allograft is used instead of autograft, 25391 remains the closest available code. Append modifier 52 to signal reduced services (autograft harvest not performed), but confirm individual carrier policy before filing — some payers accept 25391 without the modifier for allograft cases, others require documentation explaining the substitution.

The 90-day global period covers the operative day, the day-before decision visit (if modifier 57 applies), and all routine post-op management through day 90. Any unrelated procedure in that window needs modifier 79; a staged or planned return procedure needs modifier 58. Hardware removal at a later, separate encounter for a related complication takes modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.92
Practice expense RVU	10.63
Malpractice RVU	2.97
Total RVU	27.52
Medicare national rate	$919.19
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	$919.19
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,709.64

Common denial reasons

The recurring reasons claims for CPT 25391 get rejected.

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

Missing or ambiguous laterality — claim lacks LT or RT modifier, triggering payer edit or manual review.
Allograft used but 25391 billed without modifier 52, leading to payer downcoding or medical necessity denial when records are reviewed.
Separate graft harvest code billed alongside 25391 — autograft harvest is bundled and will be denied as duplicate.
Procedure billed during the global period of a prior related forearm surgery without the appropriate modifier (58, 78, or 79), resulting in global-period denial.
ICD-10 diagnosis does not support medical necessity for lengthening — codes for simple fracture without documented deformity or length discrepancy are frequently rejected.

Frequently asked questions

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

01Can I bill a separate bone graft harvest code with 25391?

No. Autograft harvest is bundled into 25391. Billing a standalone graft harvest code alongside it will trigger a bundling denial.

02The surgeon used allograft, not autograft. Which code applies?

25391 is still the correct code — CPT has no separate code for forearm lengthening with allograft. Append modifier 52 to indicate the autograft component was not performed, and document the allograft rationale. Verify carrier preference before filing, as policies vary.

03Do I need LT or RT on 25391?

Yes. Laterality modifiers are required by most payers and by CMS. Missing LT or RT is a top reason this claim is held for manual review or denied outright.

04What modifier applies if this is a staged second procedure planned from the original surgery?

Modifier 58. Use it when the return to the OR was anticipated and documented in the original operative note. It resets the global period clock. Do not use modifier 78, which is for unplanned returns related to a complication.

05Can 25391 and 25390 be billed together on the same day for the same bone?

No. 25390 describes shortening and 25391 describes lengthening of the same bone — they represent opposite procedures and cannot be reported together for a single bone in a single session.

06When is modifier 22 justified on 25391?

When the operative work is substantially greater than typical — for example, a heavily scarred revision field, presence of prior fixation hardware requiring removal, or significantly abnormal anatomy. The operative note must describe the specific factors that increased complexity and, ideally, document extended operative time.

07What is the global period for 25391, and what does it cover?

90 days. It includes the day before surgery (if a pre-op visit occurred), the operative day, and all routine post-op visits through day 90. Unrelated services in that window need modifier 79; related staged procedures need modifier 58.

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 bone operated on (radius vs. ulna), laterality, indication, osteotomy technique, graft type and harvest site (or allograft rationale), fixation method, and final length achieved — all from surgeon dictation. That prevents the most common audit flags on 25391: missing laterality, undocumented graft source, and operative notes that omit fixation detail or final bone length.

See how Mira captures CPT 25391 documentation