Prophylactic fixation of both the radius and ulna using internal hardware (nail, pin, plate, or screw), with or without bone cement, to prevent pathologic fracture at a site of structural compromise.

Verified May 8, 2026 · 6 sources ↓

Medicare: $843.37
Total RVUs: 25.25
Global, days: 90
Region: Wrist

Drawn from CMSEmednyAAPCEatonhandCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must explicitly confirm hardware was placed in both the radius and the ulna — 'both-bones fixation' cannot be inferred from a single reference to 'forearm stabilization'.
Specify the type of fixation hardware used for each bone (e.g., intramedullary nail radius, plate and screws ulna).
Document whether methylmethacrylate was used and, if so, the volume and location of application.
Identify the underlying pathology (tumor type, cyst, metabolic lesion) with reference to supporting imaging or biopsy; do not leave the structural etiology unstated.
Imaging reports (X-ray, CT, or MRI) showing cortical compromise or lesion extent should be incorporated by reference in the pre-op or H&P note to establish prophylactic — not post-fracture — intent.
Confirm the fracture had NOT yet occurred at the time of surgery; once a fracture is present, the appropriate code shifts to the applicable treatment code for radius/ulna fractures.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25492 covers prophylactic stabilization of both the radius and ulna in the same operative session. The procedure addresses bone that is structurally weakened — by tumor, cyst, metabolic disease, or impending pathologic fracture — before that fracture occurs. The surgeon implants internal fixation hardware (intramedullary nail, pin, plate, or screw construct) and may supplement with methylmethacrylate bone cement when the defect requires additional structural fill.

This is a both-bones forearm code. If only the radius is treated, bill 25490. If only the ulna, bill 25491. Billing 25492 requires documentation that hardware was placed in both bones during the same encounter. The 90-day global period applies: all routine post-op visits, wound checks, and hardware monitoring through day 90 are included. Unrelated services in that window require modifier 24 or 25 on E/M visits.

The most common clinical context is metastatic disease or benign aggressive lesions creating cortical destruction sufficient to risk spontaneous fracture. ICD-10 diagnosis coding must reflect the underlying condition (e.g., metastatic neoplasm, bone cyst, fibrous dysplasia) — a generic pathologic fracture code without an identified etiology invites payer scrutiny. Imaging studies documenting the extent of cortical involvement support medical necessity and should be referenced in the operative note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.34
Practice expense RVU	10.29
Malpractice RVU	2.62
Total RVU	25.25
Medicare national rate	$843.37
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	$843.37
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 25492 get rejected.

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

Diagnosis code reflects an acute or existing fracture rather than impending/prophylactic intent, triggering a code-diagnosis mismatch denial.
Operative note documents work on only one bone (radius or ulna), making 25492 unsupported — payer downcodes to 25490 or 25491.
Lack of imaging or pathology documentation to establish structural compromise; payer denies as not medically necessary without objective evidence of bone defect.
Modifier 59 or XS missing when billing additional forearm or wrist procedures in the same session that are NCCI-bundled with 25492.
Global period violation: post-op E/M visits billed without modifier 24 within the 90-day window are automatically denied as included in the global.

Frequently asked questions

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

01When does 25492 apply instead of a fracture treatment code?

25492 applies when the bone is at risk but has not yet fractured. Once a complete fracture is present, use the appropriate open or closed treatment code for radius/ulna fractures. Document clearly that no fracture existed at the time of surgery.

02Can 25492 be billed if only the radius received hardware and the ulna received cement alone?

That is payer-variable. Most payers expect fixation hardware in both bones to support 25492. Cement-only augmentation of one bone without hardware is unlikely to meet the threshold. Document exactly what was done to each bone and check your MAC's policy before billing 25492 in that scenario.

03What modifier applies if 25492 is done on a patient who is still in the global period from a prior forearm procedure?

If the prophylactic stabilization is unrelated to the prior procedure, use modifier 79. If it's a return for a complication or related issue from the prior surgery, use modifier 78. Do not invert these.

04Is fluoroscopic guidance separately billable during 25492?

Intraoperative fluoroscopy used for guidance during internal fixation is typically considered part of the surgical package and is not separately reportable. Check NCCI edits for the specific code pair before adding an imaging code.

05What ICD-10 codes support medical necessity for 25492?

Codes reflecting metastatic bone disease (e.g., C79.81), benign bone cysts, fibrous dysplasia, or other conditions causing cortical compromise are appropriate. The diagnosis must reflect the structural lesion, not just an unspecified bone pain code. Specificity in the ICD-10 selection directly affects medical necessity review.

06How does the 90-day global period affect post-op care billing for 25492?

All routine follow-up visits, wound care, and hardware checks through day 90 are bundled. To bill an E/M for an unrelated condition in that window, append modifier 24. If a new problem arises that requires a distinct service on the same day as a procedure, use modifier 25 on the E/M.

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 applied to each bone individually (nail, plate, pin, or screw for radius; separately for ulna), whether methylmethacrylate was placed, the underlying structural lesion, and the pre-fracture clinical status at time of surgery. That detail locks in 25492 over a unilateral code and defends prophylactic intent if a payer questions medical necessity.

See how Mira captures CPT 25492 documentation