Open repair or bone grafting of both the radius and ulna for established nonunion or malunion at the forearm.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,027.08
Total RVUs: 30.75
Global, days: 90
Region: Wrist

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm involvement of both radius AND ulna — single-bone procedures map to 25405 or 25420
Identify graft type explicitly: autograft (donor site, harvest technique), allograft (source), or combined — absence of graft detail supports 25415 instead
Document nonunion or malunion diagnosis with radiographic correlation (prior healing failure, deformity, or fibrous union)
Describe the surgical approach by name and extent of bone exposure for each bone
Record fixation method used (plate, intramedullary nail, external fixator) and hardware specifics
If modifier 22 is appended, quantify increased complexity: operative time, degree of deformity, volume of graft required, or prior hardware removal

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25426 covers open surgical repair or bone grafting of an established nonunion or malunion involving both the radius and ulna. This distinguishes it from 25420, which addresses a single-bone repair with graft, and from 25415, which covers dual-bone repair without graft. The presence of graft — whether autograft, allograft, or a combination — must be explicit in the operative note to support this code over its lower-valued neighbors.

The 90-day global period means all routine post-op visits, wound checks, and cast changes through day 90 are bundled. If a complication requires an unplanned return to the OR for a related procedure within that window, append modifier 78. A staged procedure planned at the time of the index surgery — such as a second-stage bone grafting — takes modifier 58, which resets the global clock.

Site of service matters here. HOPD and ASC facility payments differ; see the Site of Service comparison on this page. The surgeon's professional fee is the same regardless of setting, but cases involving complex deformity correction, significant bone loss requiring structural graft, or prolonged operative time may support modifier 22 with robust documentation of the increased complexity.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.04
Practice expense RVU	11.3
Malpractice RVU	3.41
Total RVU	30.75
Medicare national rate	$1,027.08
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	$1,027.08
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,169.21

Common denial reasons

The recurring reasons claims for CPT 25426 get rejected.

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

Graft not documented in operative note — payer downcodes to 25415 (repair without graft)
Only one bone addressed intraoperatively — code maps to 25405 or 25420 for single-bone procedures
Missing or insufficient imaging evidence of nonunion or malunion prior to surgery
Modifier 22 appended without supporting documentation of increased complexity or prolonged operative time
Procedure billed during a global period of a prior forearm surgery without appropriate modifier 58 or 79

Frequently asked questions

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

01What is the difference between CPT 25426 and 25420?

25420 covers open repair or grafting of a single bone — either the radius or ulna. 25426 requires that both bones are addressed with repair or graft in the same operative session. If only one bone is grafted, bill 25420 regardless of what was planned.

02Can I bill 25426 and 25415 together for the same encounter?

No. 25415 (repair of both radius and ulna, no graft) and 25426 (repair/graft of both bones) are mutually exclusive for the same operative site. Use whichever code accurately reflects what was performed — the distinction is whether bone graft was used.

03Does the 90-day global period apply to this code?

Yes. CPT 25426 carries a 90-day global. Routine post-op visits, cast and splint management, and wound care through day 90 are bundled. Bill unrelated E/M services with modifier 24, and unrelated procedures with modifier 79.

04When is modifier 58 appropriate for 25426?

Use modifier 58 when a subsequent procedure was planned at the time of the index surgery — for example, staged hardware removal or a second bone grafting session. Document the staged intent in the original operative note. Modifier 58 resets the global period; modifier 78 does not.

05Is autograft harvest separately billable with 25426?

It depends on the payer. For Medicare, iliac crest autograft harvest is generally bundled with the primary procedure. Some commercial payers allow a separate harvest code. Check payer-specific policy before unbundling the harvest, and document the donor site regardless.

06Can two surgeons bill co-surgery (modifier 62) for CPT 25426?

Modifier 62 is allowed when two surgeons with distinct roles each perform integral portions of the procedure — for example, one managing bone grafting while another handles fixation. Both surgeons must document their distinct contributions. Each bills 25426-62, and payment is typically split.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures graft type and source, named surgical approach for each bone, fixation hardware details, and explicit nonunion or malunion diagnosis from dictation. That prevents the most common downcode: 25415 in place of 25426 when graft use isn't clearly documented in the operative note.

See how Mira captures CPT 25426 documentation