Surgical repair of a structural defect in the radius or ulna using autogenous bone graft harvested during the same operative session.

Verified May 8, 2026 · 6 sources ↓

Medicare: $891.14
Total RVUs: 26.68
Global, days: 90
Region: Wrist

Drawn from CMSAAPCAbosBedrockbillingAAOS

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 — by name in the operative report; 'forearm bone' is insufficient for audit defense.
Document the nature and etiology of the defect (traumatic, post-resection, osteomyelitis, cyst, etc.) with reference to preoperative imaging.
Record the autograft harvest site, graft dimensions, and technique used to obtain the graft — harvest is bundled but must be documented.
Describe fixation method and implants used (plate, screws, K-wires) if internal fixation was applied.
Note intraoperative fluoroscopy or imaging used to confirm graft position and alignment.
Include pathology or culture results if defect was associated with infection or suspected neoplasm, to support medical necessity.

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 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25425 covers open repair of a bony defect in either the radius or ulna — caused by trauma, disease, or prior surgery — using autograft harvested from the patient's own body. Graft harvest is included in the code; don't bill separately for the harvest site. The procedure addresses defects that cannot consolidate on their own and typically involves debridement of the defect margins, graft shaping and impaction, and internal fixation as needed to restore structural continuity.

This code applies to a single forearm bone. If both the radius and ulna require autograft repair in the same session, report 25426 instead. Confusing the two is a common upcoding or undercoding error. The distinction is clinically significant, not just semantic — 25426 carries a higher work value reflecting the increased operative complexity.

The 90-day global period covers all routine postoperative care from the day of surgery through day 90. Separate E/M visits during that window require modifier 24 (unrelated) or modifier 79 (unrelated procedure) if a return to the OR is needed for an unrelated condition. A staged return for a related issue — such as delayed bone grafting of the contralateral bone — uses modifier 58, which resets the global clock.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.38
Practice expense RVU	10.45
Malpractice RVU	2.85
Total RVU	26.68
Medicare national rate	$891.14
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	$891.14
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,860.34

Common denial reasons

The recurring reasons claims for CPT 25425 get rejected.

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

Wrong code selected: 25425 billed when both bones were grafted — should be 25426, triggering a code-mismatch denial.
Medical necessity not established: operative note lacks imaging correlation or fails to explain why the defect could not heal without grafting.
Separate graft-harvest CPT code billed alongside 25425 — harvest is included and payers will bundle or deny the harvest code.
Modifier 51 not appended when 25425 is a secondary procedure in a multi-procedure session, resulting in no multiple-procedure reduction and a technical denial.
Global period conflict: postoperative E/M visit billed without modifier 24 or 25 within the 90-day window.

Frequently asked questions

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

01What's the difference between 25425 and 25426?

25425 is for a defect repaired with autograft in one forearm bone — radius or ulna. 25426 covers autograft repair of defects in both bones during the same session. Bill 25426 when both bones are addressed; billing 25425 twice instead is incorrect and will be denied or flagged.

02How does 25425 differ from 25405?

25405 repairs a nonunion or malunion of the radius or ulna with autograft — the underlying problem is a failed or malaligned fracture. 25425 addresses a structural defect (from tumor excision, infection, or bone loss) rather than a nonunion. Use the code that matches the pathology documented in the operative report.

03Is graft harvest billable separately with 25425?

No. Autograft harvest is included in 25425. Billing a separate harvest code alongside it will trigger a bundling edit and denial. Document the harvest site and technique in the operative note regardless — it supports the work already included in the code.

04Which modifier applies if the same surgeon performs this procedure again within the global period for a related reason?

Use modifier 78 for an unplanned return to the OR for a related complication during the 90-day global. Use modifier 58 if the return was planned and staged — for example, documented in the original operative note. Modifier 58 resets the global clock; modifier 78 does not.

05Can 25425 and a fracture fixation code be billed together on the same day?

Potentially yes, but check NCCI edits before billing both. If the fracture fixation and defect repair are distinct anatomic sites or distinct procedures with clear documentation, modifier 59 (or XS for separate structure) may be appropriate. Payer-specific bundling rules vary — confirm against the NCCI edit table for the specific code pair.

06When is modifier 22 appropriate for 25425?

Append modifier 22 when operative complexity significantly exceeds the typical procedure — for example, extensive scarring from prior surgery, aberrant anatomy, or a defect substantially larger than normally encountered. The operative note must quantify the additional time and describe the complicating factors explicitly. Without that documentation, payers will ignore the modifier and pay at the standard rate.

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 involved (radius vs. ulna), defect etiology, graft harvest site and dimensions, fixation method, and intraoperative imaging from dictation — the exact fields auditors check first. That eliminates the most common denial trigger for 25425: an operative note that grafts 'the forearm' without naming the specific bone, which forces a payer to guess whether 25425 or 25426 applies.

See how Mira captures CPT 25425 documentation