Open surgical treatment of a radial shaft fracture, including internal fixation with plates, screws, or rods when performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $633.95
Work RVU: 8.58
Global, days: 90
Region: Wrist

Drawn from CMSAbosAAPCNIHFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm the fracture is isolated to the radial shaft — document that no DRUJ dislocation was identified or, if present, how it was managed
Specify internal fixation construct used (e.g., volar locking plate, cortical screws, intramedullary device) — 'fixation applied' alone is insufficient for audit
Document the surgical approach by name (e.g., Henry anterior approach, Thompson posterior approach) — notes that say 'standard approach' invite auditor queries
Include preoperative imaging interpretation (X-ray, CT if obtained) confirming radial shaft fracture location and displacement
Record neurovascular status of the forearm and hand pre- and post-reduction, including assessment of the PIN (posterior interosseous nerve)
Document laterality (left vs. right) to support LT/RT modifier assignment on the claim

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25515 covers open treatment of a radial shaft fracture — the radius is surgically exposed, fragments are reduced to anatomical alignment, and internal fixation hardware (typically a plate and screws) is applied when indicated. The code includes internal fixation when performed, meaning you don't need a separate fixation code if plating is done through the same open approach.

This is an isolated radial shaft code. If the patient has a Galeazzi fracture-dislocation — radial shaft fracture plus distal radioulnar joint (DRUJ) dislocation — the correct code shifts based on how the DRUJ was managed: 25525 for open radial treatment plus closed DRUJ treatment, or 25526 when the DRUJ is also opened and the TFCC is repaired. Don't default to 25515 on Galeazzi patterns without querying whether the DRUJ was addressed; that's where undercoding and audit exposure collide.

The 90-day global period applies. All routine post-op visits, hardware checks, and wound care through day 90 are bundled. Unrelated E/M services in that window require modifier 24. If a same-day significant E/M preceded the operative decision, append modifier 57 to the E/M, not modifier 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 vs. total RVU

The work RVU (8.58) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.58
Practice expense RVU	8.66
Malpractice RVU	1.74
Total RVU	18.98
Medicare national rate	$633.95
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	$633.95
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,654.59

Common denial reasons

The recurring reasons claims for CPT 25515 get rejected.

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

Upcoding to 25525 or 25526 flagged when operative note doesn't document DRUJ dislocation or its treatment — or downcoding to 25515 when DRUJ was managed but not captured
Missing laterality modifier (LT or RT) causing claim rejection at payer edit level
Billing a separate fixation code alongside 25515 when internal fixation is already bundled into the procedure
Post-op E/M visits billed without modifier 24 during the 90-day global period, triggering automatic denial
Insufficient documentation of open approach — claims audited when the note lacks a clear description of surgical exposure and fracture visualization

Frequently asked questions

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

01When does a radial shaft fracture become a Galeazzi and require a different code?

When DRUJ dislocation is documented alongside the radial shaft fracture, you're in Galeazzi territory. Use 25525 if the DRUJ was treated closed (with or without percutaneous fixation), or 25526 if the DRUJ was opened and the TFCC repaired. 25515 is appropriate only when the DRUJ is intact or not addressed.

02Is internal fixation separately billable when plating is performed through the open approach?

No. Internal fixation is included in 25515 when performed through the open approach. Don't add a separate hardware or fixation code — it will bundle and deny.

03Can I bill both 25515 and 25545 (open ulnar shaft) if both bones are fractured?

No. Both-bone forearm fractures treated open have their own codes: 25574 for open treatment of radial and ulnar shaft fractures with fixation of radius OR ulna, and 25575 when both bones are fixated. Using 25515 plus 25545 together on a both-bone case is incorrect and will draw NCCI scrutiny.

04What modifier do I use for an E/M visit the day I decide to take the patient to surgery?

Modifier 57 on the E/M. That visit represents the decision for surgery and is payable separately from the global package. Modifier 25 is for same-day minor procedures (0- or 10-day globals), not for surgical decisions tied to 90-day global codes.

05Does the 90-day global include hardware removal if needed?

Routine hardware removal within 90 days is bundled. If hardware removal is performed as an unplanned return to the OR for a related complication, bill with modifier 78. If it's unrelated to the original fracture care, use modifier 79. Don't bill either without a clear note explaining the clinical rationale.

06Which laterality modifier is required?

LT for left forearm, RT for right. Missing laterality is a common front-end rejection. Confirm the modifier matches the operative report and the imaging order — mismatch between the two is an audit flag.

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 surgical approach by name, fixation construct details, DRUJ status assessment, and neurovascular findings from the operative dictation — and flags the note if DRUJ dislocation language appears without a corresponding code selection prompt. That prevents the most common 25515-vs-25525 undercoding pattern and gives the operative note the specificity auditors require.

See how Mira captures CPT 25515 documentation