Open repair of a radial shaft fracture combined with distal radioulnar joint (DRUJ) dislocation, including internal fixation and repair of the triangular fibrocartilage complex (TFCC) when performed — the Galeazzi fracture-dislocation pattern.

Verified May 8, 2026 · 6 sources ↓

Medicare: $895.14
Total RVUs: 26.8
Global, days: 90
Region: Wrist

Drawn from CMSFastrvuAAPCFindacodeAAOS

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 name the specific approach used (e.g., volar Henry approach) — 'standard approach' flags audits
Confirm and document DRUJ instability intraoperatively, including stress testing findings before and after fixation
Specify the implant type and configuration used for radial shaft fixation (plate size, screw count, locking vs. non-locking)
Document TFCC status explicitly — whether repaired, debrided, or found intact — to support the full code descriptor
Record intraoperative fluoroscopy findings confirming fracture reduction and DRUJ congruency before wound closure
If modifier 22 is used, document the specific complicating factors (e.g., comminution pattern, chronic instability, prior hardware) and estimated additional time

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 50 Bilateral procedure 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 ↓

CPT 25526 describes open treatment of a radial shaft fracture with associated distal radioulnar joint dislocation — the classic Galeazzi injury. The procedure requires an incision to reduce and stabilize the radial shaft fracture, typically with a plate-and-screw construct, plus direct management of the DRUJ disruption, which may include TFCC repair, DRUJ pinning, or ligamentous reconstruction depending on instability severity. Both components must be performed and documented for the code to be valid.

This is a 90-day global procedure. The global period covers the preoperative day, the day of surgery, and all routine follow-up through day 90. Any E/M service on the day before or day of surgery that represents the decision for surgery should carry modifier 57. Unrelated visits during the global window need modifier 24; additional procedures in the global period that are unplanned and related require modifier 78; unrelated procedures require modifier 79.

Bilateral Galeazzi injuries are exceptionally rare but if treated in one operative session, modifier 50 applies. For a co-surgeon arrangement — which is payable under this code per CMS data — both surgeons append modifier 62 and each submits the same code with supporting operative notes confirming distinct surgical roles. Modifier 22 is appropriate when DRUJ instability or soft-tissue complexity substantially increases operative time and work beyond the typical case; document specific findings and extra time 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	12.82
Practice expense RVU	11.25
Malpractice RVU	2.73
Total RVU	26.8
Medicare national rate	$895.14
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	$895.14
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,817.88

Common denial reasons

The recurring reasons claims for CPT 25526 get rejected.

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

Operative note documents only the radial shaft fracture repair without confirming DRUJ dislocation treatment — payers downcode to 25515
Modifier 57 missing when the surgical decision E/M was billed on the day of or day before a 90-day global procedure
TFCC or DRUJ treatment described but not linked to clinical findings — auditors treat undocumented instability as not medically necessary
Modifier 22 submitted without supporting documentation of substantially increased work, resulting in flat denial of the increased complexity claim
Co-surgeon modifier 62 denied when operative notes for both surgeons do not clearly describe distinct, separate surgical roles

Frequently asked questions

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

01What is the difference between CPT 25526 and CPT 25515?

25515 covers open radial shaft fracture repair alone. 25526 requires that same fixation PLUS open treatment of a distal radioulnar joint dislocation, which typically includes addressing TFCC pathology. If the DRUJ was dislocated and treated, bill 25526 — not 25515 with add-ons.

02Can TFCC repair be billed separately with 25526?

No. TFCC repair is included in the 25526 descriptor when performed as part of the Galeazzi repair. Billing a separate TFCC repair code on the same day would be unbundling under NCCI policy.

03Does fluoroscopy get billed separately with this procedure?

Intraoperative fluoroscopy used to guide or confirm the fracture reduction is not separately reportable with 25526 — imaging guidance integral to the procedure is bundled per NCCI Chapter 4 policy. Fluoroscopy for a distinct, separate procedure on the same date may be reportable with an appropriate modifier.

04When does modifier 22 hold up for 25526?

Modifier 22 is defensible when the operative note documents specific findings that required substantially more work — severe comminution, acute carpal tunnel requiring decompression, morbid obesity complicating exposure, or a revision scenario. Time alone is insufficient; document the clinical reason for the added complexity.

05Is a co-surgeon arrangement supported for 25526?

Yes. CMS recognizes co-surgeon billing for this code. Both surgeons append modifier 62 and submit 25526. Each operative note must describe the surgeon's distinct role — one addressing the radial shaft, the other managing the DRUJ, for example. Duplicate notes or a single combined note are a common denial trigger.

06How is a same-day E/M visit handled within the 90-day global for 25526?

If the E/M on the day of or day before surgery represents the decision to operate, append modifier 57 to the E/M code — not the procedure code. Modifier 57 is required for any major procedure (90-day global) to allow separate payment for that visit.

07What ICD-10 diagnoses are typically expected with 25526?

The primary diagnosis should reflect a radial shaft fracture with DRUJ dislocation — the Galeazzi pattern. Laterality must be specified in both the ICD-10 code and the procedure modifier (LT or RT). A mismatch between laterality in the diagnosis and the modifier is a straightforward claim rejection.

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, intraoperative DRUJ instability findings, TFCC status and any repair performed, implant details, and fluoroscopic confirmation of reduction. This prevents the most common downcode — payers reducing 25526 to 25515 when DRUJ treatment isn't explicitly documented — and gives modifier 22 claims the specific complexity language needed to survive review.

See how Mira captures CPT 25526 documentation