Surgical arrest of bone growth at the distal radius or ulna via epiphysiodesis or stapling, performed to correct or prevent limb-length discrepancy or angular deformity at the wrist.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $590.19
- Work RVU
- 7.86
- 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 ↓
- Specify which bone was treated — distal radius or distal ulna — in the operative report title and body
- Document skeletal maturity assessment, including bone age radiograph or Greulich-Pyle staging, to establish medical necessity
- State the technique used: epiphysiodesis (ablative) versus stapling (reversible), including implant type and size if stapled
- Record the clinical indication — limb-length discrepancy measurement, angular deformity degree, or both — with pre-op imaging findings
- Include laterality (left or right) in both the operative report and the charge ticket to support LT/RT modifier assignment
- If a co-surgeon or assistant surgeon was present, each operative note must independently document that surgeon's distinct contribution
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 25450 covers epiphyseal arrest procedures at the distal radius or ulna — either epiphysiodesis (permanent, using bone graft or drilling to ablate the growth plate) or stapling (temporary, using metal staples that bracket the physis to slow growth). The goal is to manipulate differential growth between paired forearm bones or between upper and lower extremities, typically in skeletally immature patients with progressive deformity or limb-length inequality. This is a pediatric orthopedic procedure; it is rarely performed in adults because the growth plate is already fused.
The code applies to one bone — distal radius OR distal ulna. If both bones are arrested in the same operative session, that changes the coding picture (see FAQ). The 90-day global period means all routine post-op visits, staple monitoring, and cast or splint changes through day 90 are bundled — bill separately only for unrelated services (modifier 79) or unplanned returns for related complications (modifier 78). Staple removal after the desired correction is achieved may fall outside the global if it occurs beyond day 90, or inside the global if it is a planned part of the same course of care — payer policy on this varies; document the clinical rationale clearly.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (7.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.67) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 7.86 |
| Practice expense RVU | 8.14 |
| Malpractice RVU | 1.67 |
| Total RVU | 17.67 |
| Medicare national rate | $590.19 |
| 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 | $590.19 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 25450 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or ambiguous laterality — claim submitted without LT or RT modifier triggers automatic rejection on many payer edits
- Lack of documented skeletal maturity data; payers deny without bone age confirmation establishing the patient is still skeletally immature
- Bundling of distal radius and distal ulna procedures billed separately on the same date without modifier 59 or XS to establish distinct anatomic sites
- Post-op visits billed without modifier 24 or 25 during the 90-day global period when the visit was for a new or unrelated problem
- Medical necessity denial when the deformity magnitude or limb-length discrepancy is not quantified in documentation — 'mild asymmetry' is insufficient
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can I bill 25450 for both the distal radius and distal ulna if I arrest both in the same session?
02Does staple removal bill separately under 25450?
03What ICD-10 diagnoses support medical necessity for 25450?
04Is 25450 billable with an assistant surgeon or co-surgeon modifier?
05How does the 90-day global period affect follow-up visits for staple monitoring?
06When is modifier 22 appropriate for 25450?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02findacode.comhttps://www.findacode.com/cpt/25450-cpt-code.html
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/25450
- 04vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2020/code/25450/info
- 05pmc.ncbi.nlm.nih.govhttps://pmc.ncbi.nlm.nih.gov/articles/PMC12088362/
- 06ams.aaos.orghttps://ams.aaos.org/Online-Store/Product-Detail?id=54670860-57C1-EF11-B8E8-6045BD03FF0D
Mira AI Scribe
Mira's AI scribe captures the operative dictation fields most critical for 25450: the specific bone treated (radius vs. ulna), laterality, surgical technique (epiphysiodesis vs. stapling), implant details, and the pre-operative deformity measurement or limb-length discrepancy that drives medical necessity. This prevents the most common audit flag — an operative note that names the procedure without documenting which bone, which side, and why the intervention was clinically warranted at this stage of skeletal development.
See how Mira captures CPT 25450 documentation