Surgical repair of nonunion or malunion involving both the radius and ulna, performed with autogenous bone graft harvested during the same operative session.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,068.49
Total RVUs: 31.99
Global, days: 90
Region: Wrist

Drawn from CMSNIHEatonhandAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative report must explicitly name both radius AND ulna as operative sites — vague language like 'forearm bones' is insufficient.
Document the nonunion or malunion diagnosis with supporting imaging (X-ray, CT) referenced in the operative note.
Confirm autograft harvest intraoperatively, specifying donor site (e.g., iliac crest) and technique — graft procurement is included in 25420 and must not be billed separately.
Record surgical approach, fixation method (plate, intramedullary nail, external fixation), and bone preparation steps for each bone.
Dictate any anatomical anomalies, excessive scarring, or prior hardware removal that would support modifier 22 for increased complexity.
Include pre- and postoperative neurovascular status of the forearm and hand.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25420 covers open surgical correction of a failed union or malunited fracture affecting both forearm bones simultaneously, using autograft bone the surgeon harvests intraoperatively — typically from the iliac crest. Because the graft harvest is included in the descriptor, you cannot separately bill 20900–20902 or similar graft-procurement codes for the same encounter; NCCI policy bars separate reporting when procurement is bundled into the primary code's descriptor.

The 90-day global period means all routine postoperative care — wound checks, cast or splint changes, hardware monitoring visits — is included through day 90. Any E/M visit for an unrelated condition during that window requires modifier 24. A return to the OR for a related complication (e.g., hardware failure, wound dehiscence) during the global uses modifier 78; an unrelated same-period procedure uses modifier 79.

Differentiate 25420 from its sibling codes carefully: 25415 covers repair of either the radius or ulna alone (not both), and 25425/25426 describe repair with allograft rather than autograft. Billing 25420 when only one bone was addressed, or when allograft was used, is a common and auditable mismatch. The operative report must name both bones and confirm autologous graft harvest to support this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.61
Practice expense RVU	11.84
Malpractice RVU	3.54
Total RVU	31.99
Medicare national rate	$1,068.49
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	$1,068.49
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,129.51

Common denial reasons

The recurring reasons claims for CPT 25420 get rejected.

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

Operative note documents repair of only one forearm bone — 25420 requires both radius and ulna; single-bone repair maps to 25415.
Separate billing of bone graft harvest codes (20900–20902) alongside 25420 — graft procurement is bundled into the descriptor and will be denied under NCCI.
Allograft used instead of autograft — 25420 is autograft-specific; allograft procedures map to 25425 or 25426.
Missing imaging documentation to support nonunion or malunion diagnosis, causing ICD-10 mismatch or medical necessity denial.
Modifier 24 absent on E/M visits for unrelated conditions billed during the 90-day global period.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 25415 and 25420?

25415 covers repair of nonunion or malunion of either the radius or the ulna alone with autograft. 25420 requires both bones to be repaired in the same operative session. Bill 25420 only when the operative report documents surgical intervention on both forearm bones.

02Can I separately bill for the iliac crest bone graft harvest with 25420?

No. Autograft procurement is explicitly included in the 25420 descriptor. Separately billing 20900, 20902, or similar harvest codes with 25420 violates NCCI bundling policy and will be denied.

03When would I use modifier 22 with 25420?

Use modifier 22 when the procedure required substantially greater work than typical — for example, removal of prior hardware, severe scarring from previous surgeries, or unusually complex nonunion anatomy. The operative note must document the specific factors driving the increased complexity; modifier 22 without supporting dictation will be rejected.

04Does 25420 cover allograft repair of both forearm bones?

No. 25420 is specific to autograft. When allograft is used for radius and ulna nonunion or malunion repair, report 25426 (with allograft, both bones). Using 25420 when the operative report documents allograft is a code-to-operative-note mismatch and an audit risk.

05How does the 90-day global period affect billing for postoperative complications?

Routine follow-up is bundled through day 90. If the patient returns to the OR for a complication related to the original repair — hardware failure, infection requiring washout — append modifier 78. If the return procedure is entirely unrelated to the forearm repair, use modifier 79. E/M visits for unrelated conditions during the global require modifier 24.

06Can two surgeons co-bill 25420 using modifier 62?

Yes, if two surgeons each perform distinct, documented portions of the procedure — for example, one managing the radius repair while the other addresses the ulna or performs the graft harvest — modifier 62 applies and each surgeon bills 25420-62. Both operative reports must describe the individual surgeon's distinct work.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures dictated confirmation that both radius and ulna were addressed, the graft donor site named and harvest technique described, fixation hardware applied to each bone, and the nonunion or malunion diagnosis linked to preoperative imaging. That documentation prevents the most common 25420 denial: an operative note that reads as a single-bone repair or fails to confirm autograft harvest, triggering a code-to-diagnosis mismatch or a bundling dispute on the graft claim.

See how Mira captures CPT 25420 documentation