Osteoplasty of both the radius and ulna involving bone shortening, performed during a single operative session.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $934.22
- Total RVUs
- 27.97
- Global, days
- 90
- Region
- Wrist
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Operative note must explicitly state that both the radius AND the ulna were shortened — 'forearm shortening' alone is insufficient and maps ambiguously to 25390.
- Specify the surgical approach and fixation method used (e.g., plate, intramedullary device); audit teams flag notes that omit hardware details for osteoplasty codes.
- Document the clinical indication for shortening both bones, including pre-op imaging findings and functional deficit (e.g., ulnar positive variance, post-traumatic deformity, Madelung deformity).
- Record intraoperative measurements confirming the amount of bone resected from each bone — this supports medical necessity and defends against downcoding to 25390.
- If modifier 22 is appended, the note must quantify the additional work: increased operative time, unusual anatomy, or complicating factors beyond the typical procedure.
- Pre-operative risk assessment and informed consent discussion documented per MIPS Measure #358 requirements for non-emergency surgery.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 25392 covers surgical shortening of both the radius and ulna in the same operative session — the bilateral forearm version of the osteoplasty shortening family. It is distinct from 25390, which addresses only one bone (radius OR ulna). Billing 25390 alongside 25392 for the same side is a guaranteed denial: NCCI treats 25390 as bundled into 25392, and payers such as Humana Medicaid have codified this edit explicitly.
The 90-day global period means the surgical fee covers all routine post-op management through day 90 — wound checks, hardware monitoring visits, and routine imaging reviews. Any visit unrelated to the forearm osteoplasty during that window requires modifier 24 on the E/M. A new, unrelated surgical problem addressed in the global period needs modifier 79; a planned staged procedure needs modifier 58.
Site of service matters here. The HOPD payment is substantially higher than the ASC rate — see the Site of Service comparison table. When surgery is performed in a hospital outpatient setting versus an ASC, that differential directly affects facility contracting and patient cost-sharing decisions.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.22 |
| Practice expense RVU | 10.72 |
| Malpractice RVU | 3.03 |
| Total RVU | 27.97 |
| Medicare national rate | $934.22 |
| 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 | $934.22 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 25392 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 25390 billed on the same claim for the same side — it is bundled into 25392 and will be denied per NCCI edits.
- Operative note describes single-bone shortening only, causing payer to downcode to 25390 (radius OR ulna).
- Missing laterality modifier (LT or RT) on claims where payer requires side identification for forearm procedures.
- Routine post-op E/M visits billed without modifier 24 during the 90-day global period, triggering global period denial.
- Insufficient documentation of medical necessity for shortening both bones simultaneously when payer expects clinical rationale distinguishing this from single-bone procedures.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What is the difference between CPT 25390 and CPT 25392?
02Can I bill 25392 bilaterally?
03What global period applies to 25392 and what does it cover?
04When is modifier 22 appropriate for this procedure?
05Does 25392 require modifier 62 for two surgeons?
06How does site of service affect reimbursement for 25392?
07Is a pre-operative E/M billed separately from 25392?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 03assets.humana.comhttps://assets.humana.com/is/content/humana/LC10134SC0221_South_Carolina_initial_code_editing_rulespdf
- 04ama-assn.orghttps://www.ama-assn.org/system/files/reporting-CPT-modifier-25.pdf
- 05mibluecrosscomplete.comhttps://www.mibluecrosscomplete.com/amslibs/content/dam/microsites/blue-cross-complete/provider/appropriate_usage_claims_modifiers.pdf
- 06qpp.cms.govhttps://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_measure_358_MIPSCQM.pdf
- 07cms.govhttps://www.cms.gov/files/document/r12052cp.pdf
Mira AI Scribe
Mira's AI scribe captures the surgeon's dictation of both bones addressed (radius AND ulna), the amount resected from each, the fixation construct, and the operative approach — the four elements auditors check first when deciding whether to downcode 25392 to 25390. Locking those details into the note at dictation prevents the most common denial path for this code.
See how Mira captures CPT 25392 documentation