Closed treatment of a radial shaft fracture with manipulation — no incision, fracture reduced by hand and immobilized.

Verified May 8, 2026 · 7 sources ↓

Medicare: $590.19
Total RVUs: 17.67
Global, days: 90
Region: Wrist

Drawn from CMSAAPCCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify fracture location as radius shaft (not distal radius or radial head — those map to different codes)
Confirm closed treatment with manipulation performed — note technique and force applied
Document pre- and post-reduction radiographic findings, including alignment achieved
Specify immobilization method applied (long-arm cast, short-arm cast, sugar-tong splint, etc.)
Record neurovascular status before and after manipulation
Note laterality (right, left, or bilateral) explicitly in the procedure note

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 57 Decision for surgery 58 Staged or related 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 7 cited references ↓

CPT 25505 covers closed (non-operative) treatment of a radius shaft fracture that requires manipulation to achieve acceptable alignment. The surgeon reduces the fracture manually — no skin incision, no internal fixation — then immobilizes the extremity, typically with a cast or splint. 'Shaft' is the key anatomic qualifier: fractures of the distal radius (e.g., Colles') fall under a different code family (25600–25609), and fractures managed without any manipulation are reported with 25500.

The 90-day global period covers the manipulation, post-reduction imaging interpretation, cast changes, and routine follow-up through day 90. Separate billing for cast application is not payable within the global unless a different physician applies it. Imaging ordered and interpreted by the treating physician on the day of service is generally included; billing pre- and post-reduction films separately under the global requires confirming payer policy.

Bilateral radial shaft fractures are uncommon but do occur. The MUE for 25505 is 1 per line, so bilateral cases require modifier 50 (or RT/LT on separate lines per payer preference) rather than two units on a single line. If the fracture subsequently requires open reduction or percutaneous fixation — whether planned at the time or as a later staged decision — escalate to 25515 or 25525 as appropriate.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.31
Practice expense RVU	11.16
Malpractice RVU	1.2
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 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25505 get rejected.

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

Incorrect code selected — distal radius fracture billed as 25505 instead of the 25600 family
Missing documentation of manipulation — payers default to 25500 (without manipulation) if manipulation isn't explicitly documented
Global period conflict — E/M or cast services billed during the 90-day global without modifier 24 or 25
Bilateral case submitted with two units on one line rather than modifier 50 or RT/LT, triggering MUE denial
Imaging billed separately by the treating physician on the same day without confirming payer policy on global inclusion

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What's the difference between 25505 and 25600?

25505 is for shaft fractures of the radius; 25600 covers distal radius fractures (Colles', Smith's, etc.). The shaft is the middle third of the bone. If the fracture line is at or near the wrist joint, you're in the 25600–25609 family.

02Is cast application separately billable with 25505?

No, for the treating physician. Cast application by the same physician on the same day is bundled into the fracture care code. If a different provider applies the cast, that provider may bill separately.

03How do you bill 25505 for bilateral radial shaft fractures?

The MUE for 25505 is 1 per line. Bill with modifier 50 on a single line, or on two separate lines with LT and RT — confirm your payer's preference. Do not submit two units without a laterality modifier.

04If the closed reduction fails and the patient goes to the OR, what modifier applies?

If the open procedure is performed during the 90-day global and was not planned at the time of the closed reduction, use modifier 78 (unplanned return to OR for a related procedure). If it was staged and planned from the outset, modifier 58 applies.

05Can you bill an E/M on the same day as 25505?

Yes, if the E/M is significant and separately identifiable — for example, evaluation of an unrelated condition. Append modifier 25 to the E/M. Routine fracture assessment folded into the decision to treat is not separately billable.

06Does 25505 include post-reduction imaging?

CMS policy bundles imaging interpretation by the treating physician into fracture care. Some payers follow this; others allow separate billing for the radiologic supervision and interpretation component. Verify with each payer before billing imaging separately on the date of manipulation.

07When would modifier 22 be appropriate with 25505?

When the manipulation required substantially more work than typical — for example, a highly comminuted shaft fracture requiring prolonged or repeated reduction attempts. Document the additional time, complexity, and effort explicitly; without that, modifier 22 claims are routinely rejected.

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 site (radius shaft vs. distal radius), explicit documentation of manipulation technique and force, pre- and post-reduction alignment findings, immobilization type applied, and neurovascular exam before and after reduction. That specificity prevents the two most common downcodes: payers reassigning to 25500 when manipulation isn't clearly documented, and coders defaulting to the distal radius family when anatomy isn't named.

See how Mira captures CPT 25505 documentation