Prophylactic surgical reinforcement of the radius using internal fixation (nailing, pinning, plating, or wiring), with or without bone cement, to prevent pathologic fracture.

Verified May 8, 2026 · 6 sources ↓

Medicare: $678.71
Total RVUs: 20.32
Global, days: 90
Region: Wrist

Drawn from CMSEmednyCgsmedicareFastrvuAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fixation method(s) used: nail, pin, plate, and/or wire — 'internal fixation' alone is insufficient
Document the pathologic or structural basis for prophylactic intervention (e.g., metastatic lesion, primary bone tumor, radiation necrosis, severe osteopenia with impending fracture)
State whether methylmethacrylate was used and the volume/extent of its application
Include preoperative imaging findings (X-ray, CT, or MRI) confirming structural compromise and fracture risk
Laterality must be explicit — right, left, or bilateral — in both the operative note and the diagnosis coding
Operative note must distinguish prophylactic treatment from fracture repair; 'prophylactic' intent should be stated explicitly

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 58 Staged or related 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 6 cited references ↓

CPT 25490 covers surgical stabilization of a structurally compromised radius before fracture occurs — not treatment of an existing fracture. The surgeon reinforces the bone using one or more fixation methods (intramedullary nail, pins, plates, or wires), and may augment with methylmethacrylate bone cement when cortical integrity is severely diminished. Classic indications include impending pathologic fracture from primary or metastatic bone lesion, radiation necrosis, or severe osteopenic defect where fracture risk is imminent.

This is a 90-day global procedure. All routine post-op management, wound checks, and implant-related follow-up through day 90 are bundled. Unrelated E/M visits in that window require modifier 24; a separately identifiable problem addressed same-day preoperatively needs modifier 25 on the E/M. For isolated ulna stabilization, use 25491; simultaneous radius and ulna use 25492 — do not stack 25490 + 25491 bilaterally on the same operative session.

For bilateral radius procedures at the same session (rare but possible in systemic disease), report with modifier 50 on a single line for professional billing. ASC facilities report on two lines using LT and RT. Document the fixation method, the underlying pathology driving the prophylactic decision, and whether methylmethacrylate was used — all three affect medical necessity review.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.49
Practice expense RVU	8.81
Malpractice RVU	2.02
Total RVU	20.32
Medicare national rate	$678.71
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	$678.71
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25490 get rejected.

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

Code billed as fracture repair when documentation describes intact bone — payers require clear prophylactic intent
Missing or insufficient imaging evidence of impending pathologic fracture, triggering medical necessity denial
Simultaneous billing of 25490 and 25491 on the same claim without modifier to indicate separate anatomic sites
Lack of documented underlying pathology (tumor, lesion, necrosis) to justify prophylactic fixation over conservative management
Global period violation — post-op E/M billed without modifier 24 within the 90-day window

Frequently asked questions

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

01What distinguishes 25490 from a distal radius fracture repair code like 25607?

25490 is used when the radius is intact but structurally at risk — the surgery prevents a fracture from occurring. Codes like 25607 describe treatment of a fracture that has already happened. The operative note must explicitly state prophylactic intent; if the documentation reads like fracture management, payers will recode or deny.

02Can 25490 and 25491 be billed together for the same operative session?

Only if both the radius and ulna were treated at separate sites and documentation supports distinct work for each. For simultaneous radius and ulna prophylactic fixation, 25492 (radius AND ulna) is the correct single code. Stacking 25490 + 25491 without a distinct clinical rationale risks NCCI bundling denial.

03Is methylmethacrylate separately billable when used with 25490?

No. The code descriptor explicitly includes methylmethacrylate as an optional component of the procedure. It is not separately reportable — billing it as a supply or add-on will be bundled back.

04What ICD-10 diagnoses support medical necessity for 25490?

Impending pathologic fracture codes (M84.53x for radius) are the primary drivers. Metastatic bone disease, primary bone tumors, radiation osteonecrosis, and severe osteoporosis with documented fracture risk are all accepted. A diagnosis of an existing fracture does not support 25490 — use a fracture repair code instead.

05How does the 90-day global period affect post-op billing?

All routine follow-up through day 90 is bundled — no separate E/M for wound checks, suture removal, or implant-related visits. If you see the patient for an unrelated condition during that window, bill the E/M with modifier 24. A new and distinct procedure unrelated to the radius fixation uses modifier 79.

06When is modifier 22 appropriate for 25490?

Use modifier 22 when the work substantially exceeds typical — for example, severe cortical destruction requiring extended fixation construct, unusually complex bone anatomy from prior surgery, or significantly increased operative time. Attach a cover letter with operative time and a description of the added complexity; payers will request records and RVU justification.

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 fixation method by name (nail, pin, plate, or wire), documents whether methylmethacrylate was applied, and records the underlying structural pathology — the three elements auditors check first on prophylactic fixation claims. This prevents downcoding to a fracture repair code or denial for missing medical necessity justification.

See how Mira captures CPT 25490 documentation