Closed treatment of a radial shaft fracture, performed without manipulation of the fracture fragments.

Verified May 8, 2026 · 5 sources ↓

Medicare: $326.66
Total RVUs: 9.78
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm no manipulation was performed — document fracture position as acceptable without reduction
Specify the fracture location on the radial shaft, including proximal, middle, or distal third
Document laterality (left vs. right radius) and mechanism of injury
Record type and duration of immobilization applied (cast, splint, brace)
If splitting global care with another provider, document agreed post-op care transfer date and range in Box 19 of the CMS-1500
For same-day E/M, document a separately identifiable medical decision or history to support modifier 25 or 57

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 25500 covers closed (non-operative) treatment of a radial shaft fracture when no manipulation is required — the fracture is stable enough that repositioning is unnecessary. The code includes the initial fracture care visit, application of any immobilization device, and all routine follow-up within the 90-day global period. If manipulation is needed, 25505 is the correct code instead.

The 90-day global period bundles the surgery date, the day-before visit (if applicable), and all routine post-op management through day 90. Any E/M visit within that window for an unrelated problem requires modifier 24. If you're billing an E/M on the same day as the fracture care and the decision to treat was made that day, append modifier 57 to the E/M — without it, the visit will deny as included in the global package.

When care is split between providers — for example, the treating physician performs fracture care but transfers follow-up to another surgeon — use modifiers 54 and 55 to divide the global. The treating surgeon bills 25500-54 (surgical care only); the follow-up provider bills 25500-55 (post-op management only) with the date range documented in Box 19 of the CMS-1500. Both claims must account for the full 90-day global or CMS will flag the split.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.54
Practice expense RVU	6.73
Malpractice RVU	0.51
Total RVU	9.78
Medicare national rate	$326.66
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	$326.66
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 25500 get rejected.

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

E/M billed same-day without modifier 57 when the visit represented the decision for fracture care — denied as included in the global
Missing or mismatched laterality modifier when payer requires LT or RT for unilateral forearm procedures
Modifier 54/55 split claims rejected due to missing date range in Box 19 of the CMS-1500
Code billed when documentation supports manipulation was performed — should be 25505 instead
Post-op visit billed within the 90-day global without modifier 24 for an unrelated condition

Frequently asked questions

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

01What is the global period for CPT 25500?

90 days. That covers the fracture care visit, any immobilization, and all routine follow-up through day 90. Unrelated problems billed within that window need modifier 24 on the E/M.

02When should I use 25500 vs. 25505?

Use 25500 only when no manipulation is performed — the fracture is in acceptable alignment without reduction. If you manipulate the fracture to achieve position, bill 25505 instead. Documentation must explicitly state no manipulation was needed.

03How do I bill when the treating surgeon won't provide any of the 90-day follow-up?

The treating surgeon bills 25500-54 (surgical care only). The follow-up provider bills 25500-55 (post-op management only) with the care date range in Box 19 of the CMS-1500. Both providers must account for the full global window between them.

04Can I bill an E/M on the same day I bill 25500?

Yes, if the E/M is significant and separately identifiable. Append modifier 25 to the E/M. If the visit was the decision point to provide fracture care, use modifier 57 on the E/M instead — modifier 57 is required when the decision for treatment occurs the day before or the day of the procedure.

05Do I need a laterality modifier for CPT 25500?

Many payers require LT or RT for unilateral forearm procedures. Confirm with your MAC or commercial payer contracts. Missing laterality is a common, easily preventable denial reason for this code.

06Can 25500 be billed bilaterally?

Bilateral radial shaft fractures are rare but possible. If treating both sides, append modifier 50 and document both injuries clearly. Some payers require separate line items with LT and RT instead of a single modifier 50 claim — verify your payer's preference.

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 fracture location on the radial shaft, confirms the absence of manipulation, documents laterality, and records the immobilization type applied. It flags when the treating note describes any repositioning or reduction attempt — catching a 25500-vs-25505 mismatch before the claim goes out, which is one of the most common audit triggers for closed radial fracture billing.

See how Mira captures CPT 25500 documentation