Surgical repair of radius or ulna nonunion or malunion using an autograft, including harvest of the graft from the iliac crest or another donor site.

Verified May 8, 2026 · 6 sources ↓

Medicare: $939.23
Total RVUs: 28.12
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeEatonhandMdclarity

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 repaired — radius or ulna — and the laterality (left/right).
State whether the condition was nonunion or malunion, supported by preoperative imaging.
Identify the autograft donor site by name (e.g., iliac crest, distal radius) and document the harvest technique.
Describe the osteotomy or bone preparation performed at the nonunion/malunion site.
Document fixation method used (plate, intramedullary nail, external fixator, etc.).
Include intraoperative imaging or fluoroscopy findings confirming alignment and graft placement if obtained.

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 58 Staged or related 59 Distinct service 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25405 covers open repair of a nonunion or malunion of the radius or ulna — either bone, not both simultaneously — where the surgeon cuts through the improperly healed or stalled bone, corrects alignment, and stabilizes the repair using bone graft harvested from the patient's own body (autograft). The iliac crest is the most common donor site. Critically, autograft harvest is included in 25405; you cannot separately bill graft procurement codes (e.g., 20900–20902) when this code is used.

The adjacent code 25400 covers the same nonunion/malunion repair without a graft — or with allograft only. If the surgeon used allograft (donor bone, not the patient's own), report 25400. If the case involved allograft and the added complexity warrants it, modifier 22 may be appropriate, but the allograft itself is not separately billable under 25400 per NCCI policy. Reserve 25405 strictly for autograft cases.

This code carries a 90-day global period. All routine post-op visits, wound checks, and hardware monitoring through day 90 are bundled. Unrelated problems treated in that window require modifier 24 on the E/M. A staged or planned return to address the same site (e.g., hardware removal after union) uses modifier 58.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.63
Practice expense RVU	10.62
Malpractice RVU	2.87
Total RVU	28.12
Medicare national rate	$939.23
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	$939.23
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,893.00

Common denial reasons

The recurring reasons claims for CPT 25405 get rejected.

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

Billing autograft harvest separately (20900–20902) when graft procurement is already included in 25405.
Using 25405 when only allograft was used — that maps to 25400, not 25405.
Missing laterality modifier (LT or RT), triggering payer edit for bilateral ambiguity.
Nonunion/malunion diagnosis not supported by imaging reports in the medical record.
Routine post-op E/M visits billed without modifier 24 during the 90-day global period.

Frequently asked questions

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

01What is the difference between CPT 25400 and 25405?

25400 is nonunion/malunion repair without autograft — or with allograft only. 25405 requires autograft from the patient's own body, with graft harvest included in the code. If the surgeon used iliac crest or another autograft site, bill 25405. If donor bone only, bill 25400.

02Can I separately bill for iliac crest bone graft harvest when using 25405?

No. Autograft harvest is bundled into 25405 by code definition. Separately billing 20900 or 20902 will be denied under NCCI bundling rules.

03Does 25405 apply to both radius and ulna in the same operative session?

No. The code descriptor specifies radius OR ulna — one bone per code. If both bones required nonunion/malunion repair with autograft in the same session, report 25405 for the primary bone and discuss with the surgeon whether modifier 51 plus documentation of distinct procedures supports billing the second repair.

04What modifier is needed if the surgeon returned to the OR within the 90-day global to remove hardware after union?

Use modifier 58 — staged or related procedure by the same physician during the global period. Hardware removal after confirmed union is a planned, related return, not an unplanned complication.

05Is fluoroscopic guidance separately billable with 25405?

Generally no. CMS NCCI policy treats intraoperative fluoroscopy as integral to most musculoskeletal procedures when it guides the repair. Verify with your payer; some commercial contracts differ, but Medicare bundles it.

06Can 25405 be billed with an E/M on the same day as surgery?

Only if the E/M was a separate, substantive decision-making visit — for example, a preoperative visit the day before, or an unrelated problem addressed the same day. Append modifier 57 if the E/M led to the decision for surgery, or modifier 25 if it was a distinct problem on the same DOS. Routine pre-op clearance is bundled into the global.

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 repaired (radius vs. ulna), laterality, nonunion vs. malunion designation, autograft donor site with harvest technique, fixation hardware, and intraoperative imaging findings — all from dictation. That prevents the two most common denials: missing laterality and unbundled graft harvest codes.

See how Mira captures CPT 25405 documentation