Repair of nonunion or malunion of the radius or ulna without bone graft, using compression or similar technique
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $737.16
- Total RVUs
- 22.07
- 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 6 cited references ↓
- Specify which bone is being repaired — radius or ulna — not just 'forearm'
- Document diagnosis as nonunion or malunion with supporting imaging (x-ray or CT) confirming failed or malunited healing
- Confirm no bone graft was used; if graft was added intraoperatively, 25400 is no longer the correct code
- Record the fixation technique used (e.g., compression plating, intramedullary nail) — do not write 'standard approach'
- Note laterality (left or right forearm) explicitly in the operative report and diagnosis documentation
- If modifier 22 is appended, include a detailed narrative in the operative note quantifying the additional work beyond typical
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 6 cited references ↓
CPT 25400 covers surgical repair of an established nonunion or malunion of the radius or ulna when no bone graft is required — the classic example is rigid compression fixation that stimulates healing at the fracture site without supplemental graft material. This distinguishes 25400 from 25405 (same repair with autograft) and 25415/25420 (with allograft or combined graft). The code applies to either bone — radius or ulna — but only one bone per operative session; if both are addressed, expect payer scrutiny and support each site with distinct documentation.
The 90-day global period means all routine follow-up, hardware checks, and cast or splint management through day 90 are bundled. Unrelated problems billed in that window need modifier 24 (E/M) or 79 (procedure). An unplanned return to the OR for hardware failure or wound complication tied to the original repair uses modifier 78. Laterality modifiers (LT/RT) are required by most payers and should be applied consistently from the operative note through the claim.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11 |
| Practice expense RVU | 8.91 |
| Malpractice RVU | 2.16 |
| Total RVU | 22.07 |
| Medicare national rate | $737.16 |
| 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 | $737.16 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,900.96 |
Common denial reasons
The recurring reasons claims for CPT 25400 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or mismatched laterality — claim lacks LT/RT modifier while operative report specifies a side
- Upcoding flag when 25400 is billed for an acute fracture ORIF instead of a true nonunion or malunion repair
- Code billed with graft CPT (e.g., 20900-series) without switching to 25405 or 25415, triggering a bundling edit
- Insufficient imaging documentation to establish nonunion or malunion diagnosis before the procedure date
- Routine post-op visit billed separately inside the 90-day global without modifier 24 or 79
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What separates 25400 from 25405?
02Can 25400 be billed for an acute forearm fracture that was just fixed?
03If both the radius and ulna are repaired in the same session, how do I bill?
04What modifier applies if the patient returns to the OR for hardware failure at the same site within the 90-day global?
05Is bone graft harvest separately billable with 25400?
06Does 25400 carry a global period, and what's bundled into it?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/25400
- 03findacode.comhttps://www.findacode.com/cpt/25400-cpt-code.html
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/25400
- 05eatonhand.comhttps://www.eatonhand.com/coding/n25400.htm
- 06cms.govhttps://www.cms.gov/files/document/r12052cp.pdf
Mira AI Scribe
Mira's AI scribe captures the bone repaired (radius vs. ulna), operative side, fixation technique, and explicit confirmation that no graft material was used — all from dictation. That prevents the most common audit flag: an operative note that's silent on graft status, which forces a coder to guess between 25400 and 25405 and often results in a hold or denial.
See how Mira captures CPT 25400 documentation