Surgical arrest of bone growth at the distal radius and ulna epiphyses using implanted hardware (screws or staples) to correct angular or length deformity in a skeletally immature patient.

Verified May 8, 2026 · 5 sources ↓

Medicare: $691.40
Total RVUs: 20.7
Global, days: 90
Region: Wrist

Drawn from CMSAAOSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must specify which bone(s) treated — distal radius, distal ulna, or both — and confirm epiphyseal/physeal level of hardware placement.
Implant type and size documented by name (e.g., tension-band staple, cannulated screw, 8-plate); include lot/serial numbers per facility implant log requirements.
Pre-operative imaging (X-ray or MRI) confirming open growth plates and documenting the deformity or length discrepancy that indicates epiphysiodesis.
Bone age assessment (left-hand radiograph with Greulich-Pyle or Tanner-Whitehouse staging) to support medical necessity in a skeletally immature patient.
ICD-10 diagnosis tied directly to the growth arrest indication — e.g., M21.031 (cubitus valgus, right wrist), Q74.0 (Madelung deformity), or M89.231/M89.232 (growth plate disorder) — to avoid CPT-ICD mismatch denial.
Laterality clearly stated in both the pre-op diagnosis and operative note body; ambiguous laterality is a top audit flag for this code.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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 25455 describes epiphysiodesis of the distal radius and/or ulna — a procedure performed in pediatric or adolescent patients to intentionally slow or halt longitudinal bone growth at one or both wrist-side growth plates. The surgeon implants screws, staples, or tension-band plates into the epiphyseal region to create a temporary tether effect, correcting conditions such as ulnar positive variance, Madelung deformity, or length discrepancy between the radius and ulna secondary to growth disturbance.

The 90-day global period covers the operative encounter, the day-before visit, and all routine post-op management through day 90 — including hardware monitoring visits and cast or splint changes directly related to the index procedure. If the implanted hardware is subsequently removed during a separate planned encounter, that removal falls outside the global only if it constitutes an unrelated or separately scheduled procedure; bill with modifier 58 if it was staged and planned at the time of the original surgery, or modifier 79 if truly unrelated.

Bilateral cases (simultaneous distal radius and ulna epiphysiodesis on both wrists) require modifier 50. When the procedure is performed unilaterally, append LT or RT per payer requirement. Same-day decision-for-surgery E&M encounters require modifier 57; a separate, significant E&M on the same day as a major procedure requires modifier 57, not 25.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.47
Practice expense RVU	9.21
Malpractice RVU	2.02
Total RVU	20.7
Medicare national rate	$691.40
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	$691.40
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 25455 get rejected.

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

Skeletal maturity not documented — payers deny when bone age or open physes are not supported by pre-op imaging interpretation in the record.
ICD-10 mismatch or non-specific diagnosis code (e.g., M21.9 unspecified acquired deformity of limb) not accepted as medically necessary for epiphysiodesis.
Bilateral procedure billed as two separate line items without modifier 50, or modifier 50 appended without payer pre-authorization for bilateral surgical session.
Post-op hardware removal billed during the 90-day global period without a supporting modifier (58 for staged, 78 for unplanned related return) causing automatic bundling denial.
Modifier 57 missing when the decision for surgery was made at the same-day E&M encounter, resulting in the E&M being denied as bundled into the global package.

Frequently asked questions

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

01Does 25455 cover hardware removal after the epiphysiodesis?

Not within the 90-day global. Planned staged removal billed after the global expires uses a separate procedure code with modifier 58 if it was part of the original surgical plan, or modifier 79 if it was unrelated. An unplanned return to the OR for a related complication during the global uses modifier 78.

02Can 25455 be billed bilaterally when both wrists are treated in the same session?

Yes. Append modifier 50 and bill as a single line item, or follow the individual payer's bilateral billing instructions (some require LT and RT on separate lines). Verify prior authorization covers bilateral in the same session — some commercial plans require separate authorizations per extremity.

03What ICD-10 codes best support medical necessity for 25455?

Common accepted diagnoses include Madelung deformity (Q74.0), acquired cubitus valgus or varus (M21.0x1–M21.0x2), physeal growth disturbance of radius or ulna (M89.231/M89.232), and ulnar positive variance with documented length discrepancy. Avoid unspecified deformity codes; payers flag them for pre-payment review.

04Is a same-day E&M billable with 25455?

Only if the E&M was a decision-for-surgery visit — append modifier 57. If the patient was already scheduled and the visit is routine pre-op counseling, it's bundled into the global. The fact that a patient is new to the practice alone does not justify a same-day E&M with a major procedure.

05How does site of service affect reimbursement for 25455?

HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. The professional fee (physician component) also carries a facility rate reduction when billed in a facility setting versus a non-facility setting. Confirm your contracted rates and whether the case is appropriate for ASC versus HOPD based on patient age and anesthesia needs.

06Can modifier 22 be used if the procedure was unusually complex due to prior surgery or severe deformity?

Yes, but documentation must explicitly describe what made the work substantially greater than typical — adhesions from prior hardware, deformity severity requiring intraoperative imaging, or extended operative time with a narrative reason. Attaching modifier 22 without a supporting operative note increases audit risk and will likely be down-coded on review.

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 specific bones treated (distal radius, distal ulna, or both), implant type and laterality directly from surgeon dictation, and flags whether bone age documentation and open-physis confirmation appear in the pre-op workup. This prevents the two most common denials for 25455: skeletal maturity not supported in the record, and laterality ambiguity that triggers audit-level review.

See how Mira captures CPT 25455 documentation