Closed treatment of a radial shaft fracture combined with closed reduction of a distal radioulnar joint dislocation — the Galeazzi fracture-dislocation — without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $636.62
Work RVU: 6.34
Global, days: 90
Region: Wrist

Drawn from CMSAAPCEmednyFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm both injury components: radial shaft fracture AND distal radioulnar joint dislocation documented in the note
State that treatment was closed (no incision made for either the fracture or the DRUJ)
Document reduction technique used for the radial shaft fracture (e.g., traction, manipulation method)
Record fluoroscopic or imaging confirmation of post-reduction alignment and DRUJ stability
Specify laterality (left or right) in the operative or procedure note
If an E/M was performed same-day or the day before to decide on surgery, document medical decision-making supporting that decision

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 59 Distinct service 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 ↓

25520 covers the closed management of a Galeazzi fracture-dislocation: a radial shaft fracture occurring alongside dislocation of the distal radioulnar joint (DRUJ). Both components — the radial shaft fracture and the DRUJ dislocation — are treated without opening the skin. This is a distinct injury pattern that requires coding beyond a simple radial shaft fracture; the DRUJ dislocation component is what separates 25520 from 25500/25505.

The 90-day global period means the procedure is treated as a major surgery. Any E/M service the day before or day of surgery that drives the decision to operate requires modifier 57. Post-op E/M visits unrelated to the fracture during the global window need modifier 24. Always append LT or RT to indicate laterality — payers routinely reject laterality-absent fracture claims.

If closed reduction fails intraoperatively and the surgeon converts to open fixation of the radius (with or without open DRUJ treatment), step up to 25525 or 25526. Billing 25520 when the operative note documents an incision is a misrepresentation and an audit trigger. Document reduction technique, fluoroscopic confirmation of alignment, and DRUJ stability testing explicitly 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 vs. total RVU

The work RVU (6.34) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.06) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.34
Practice expense RVU	11.38
Malpractice RVU	1.34
Total RVU	19.06
Medicare national rate	$636.62
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	$636.62
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 25520 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier, triggering automatic rejection by many payers
Upcoding flag — operative note documents an incision but 25520 (closed) was billed instead of 25525 or 25526
Incomplete injury documentation — DRUJ dislocation not explicitly noted, making 25520 unsupportable over 25505
Global period conflict — post-op E/M billed during the 90-day global without modifier 24 or 25
Presurgical E/M denied — modifier 57 omitted when an E/M on the day of or day before the procedure drove the surgical decision

Frequently asked questions

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

01What makes 25520 different from 25505?

25505 is closed treatment of a radial shaft fracture with manipulation only. 25520 adds closed treatment of a DRUJ dislocation — the Galeazzi component. If the operative note doesn't document DRUJ dislocation and its reduction, 25520 is not supportable.

02When should I step up to 25525 or 25526?

Use 25525 when the radial shaft fracture requires open treatment (incision and internal fixation) but the DRUJ dislocation is managed closed or with percutaneous fixation. Use 25526 when both the radius and the DRUJ are treated openly, including TFCC repair. Billing 25520 after any incision is a misrepresentation.

03Which modifier do I use for the pre-op E/M with a 90-day global?

Modifier 57. All radial/ulnar fracture codes in this family carry a 90-day (major) global. Append modifier 57 to any E/M on the day of or day before surgery that drove the decision to operate. Modifier 25 applies when the associated procedure has a 0- or 10-day global — not here.

04Do I need LT or RT on every claim?

Yes. Append LT or RT to 25520 on every claim. Most payers reject laterality-absent fracture codes outright. This is one of the most avoidable denial reasons for forearm fracture billing.

05Can I bill for an unplanned return to the OR during the 90-day global if the DRUJ redislocates?

If the surgeon returns to the OR to re-reduce a DRUJ dislocation related to the original injury during the global period, append modifier 78 (unplanned return for a related procedure). If the return is for a completely unrelated condition, use modifier 79 instead.

06Is 25520 ever billed bilaterally?

Bilateral Galeazzi fracture-dislocations are extremely rare, but if they occur, modifier 50 applies. Document each side independently in the operative note. Most payers will require individual line items with LT and RT rather than a single line with modifier 50 — verify payer preference before submitting.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific injury pattern from dictation — radial shaft fracture plus DRUJ dislocation — and flags whether treatment was closed throughout, including DRUJ reduction. It records laterality, reduction technique, and fluoroscopic confirmation language. This prevents the two most common 25520 audit triggers: a note that omits the DRUJ component (collapsing to 25505) and a note that documents an incision while closed-treatment code 25520 is billed.

See how Mira captures CPT 25520 documentation