Surgical correction of nonunion or malunion affecting both the radius and ulna simultaneously, using compression or similar non-graft fixation technique.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $895.48
- Total RVUs
- 26.81
- 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 ↓
- Confirm both radius AND ulna are involved — operative note must name each bone explicitly, not just 'forearm bones'
- Specify fixation technique used (e.g., compression plating, intramedullary nail, external fixation) to justify 'without graft' coding
- Document preoperative imaging confirming nonunion or malunion at both sites (X-ray, CT, or MRI with report)
- Record prior treatment history — prior fracture fixation, cast immobilization, or earlier failed repair — to establish clinical necessity
- Note absence of bone graft harvest; if graft was obtained intraoperatively, 25420 applies instead
- Include intraoperative findings at each bone's nonunion/malunion site to support bilateral repair
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 25415 describes open surgical repair of failed or malpositioned healing involving both forearm bones — the radius and the ulna — without the use of bone graft. The surgeon resects fibrous or malaligned tissue at the nonunion or malunion site, then achieves bony apposition using compression plating, intramedullary fixation, or similar internal fixation hardware. The 'without graft' designation is the critical distinction separating this code from 25420, which covers the same bilateral repair with autograft.
The bilateral involvement of both bones is equally critical. If only one forearm bone requires repair, bill 25400 (without graft) or 25405 (with autograft) instead. Using 25415 for single-bone pathology is a coding error that auditors and payers catch routinely — operative notes must confirm involvement of both radius and ulna.
This is a 90-day global procedure. All routine postoperative visits, hardware checks, and cast or splint changes through day 90 are included. Separate E/M services during the global require modifier 24 (unrelated) or modifier 25 (significant, separately identifiable, same-day). If the surgeon anticipates a staged second procedure — such as a subsequent bone-grafting session — document that intent in the original operative note and append modifier 58 to the return procedure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.46 |
| Practice expense RVU | 10.48 |
| Malpractice RVU | 2.87 |
| Total RVU | 26.81 |
| Medicare national rate | $895.48 |
| 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 | $895.48 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,925.79 |
Common denial reasons
The recurring reasons claims for CPT 25415 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Single-bone repair coded as 25415 — payer downcodes to 25400 when operative note documents only radius or only ulna
- Bone graft used intraoperatively but 25415 billed — should be 25420; auditors cross-reference anesthesia and pathology records
- Medical necessity not established — missing imaging documentation of confirmed nonunion or malunion prior to surgery
- Global period conflict — postoperative E/M billed within 90-day window without modifier 24 or 25
- Unbundling with 25400 — attempting to bill both the single-bone and dual-bone repair codes for the same operative session
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the exact difference between 25415 and 25400?
02When does 25415 become 25420?
03Can 25415 and 25420 be billed together for the same surgery?
04What modifier applies if the surgeon returns for a planned bone grafting procedure within the 90-day global?
05Is modifier 22 ever justified for 25415?
06How does the global period affect same-day E/M billing with 25415?
07What ICD-10 diagnoses are typically required to establish medical necessity?
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/25415
- 03emedny.orghttps://www.emedny.org/ProviderManuals/Physician/PDFS/Physician%20Procedure%20Codes%20Sect5_2009-1.pdf
- 04pmc.ncbi.nlm.nih.govhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6903820/
- 05eatonhand.comhttps://www.eatonhand.com/coding/n25415.htm
- 06aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
Mira AI Scribe
Mira's AI scribe captures the operative dictation detail that makes or breaks 25415 billing: explicit naming of both the radius and ulna as nonunion or malunion sites, the specific fixation technique applied, and confirmation that no bone graft was harvested. That documentation prevents the two most common denial patterns — downcoding to 25400 for single-bone repair and upcoding pressure to 25420 when no graft was used.
See how Mira captures CPT 25415 documentation