Closed treatment of an ulnar shaft fracture without any fracture manipulation performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $301.94
Work RVU: 2.18
Global, days: 90
Region: Wrist

Drawn from CMSAbosAAOSNIH

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 — operative or clinical note must explicitly state fracture was treated without reduction
Specify the ulnar shaft as the fracture site, distinguishing it from distal or proximal ulnar fractures
Document the type of immobilization applied (splint, cast, brace) and materials used
Record pre- and post-treatment radiographic findings confirming acceptable alignment without reduction
Note neurovascular status of the forearm and hand at time of treatment
Document the mechanism of injury and clinical presentation supporting conservative management 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 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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25530 covers non-operative management of an isolated ulnar shaft fracture where the treating physician does not attempt to reduce or manipulate the fracture fragments. No incision is made. The bone is immobilized — typically with a splint, brace, or cast — and the fracture is left in its current position. This is the appropriate code when alignment is acceptable and manipulation is not clinically indicated.

The 90-day global period applies. That window covers the initial application of any immobilization device, routine follow-up visits, and removal of casting materials. Any E/M service on the day of treatment requires modifier 25 on the visit if a separately identifiable service was provided. If the decision for a subsequent surgical procedure is made during the global period, modifier 57 (decision for surgery) attaches to that E/M. Unrelated visits in the global period need modifier 24.

Don't confuse 25530 with its sibling codes: 25535 is closed treatment with manipulation, 25545 is open treatment with internal fixation when performed, and 25560/25565 address combined radial and ulnar shaft fractures. If you performed any fracture reduction — even a minor one — 25530 is the wrong code. The distinction between 'without manipulation' and 'with manipulation' is the single most common audit flag for this code family.

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 (2.18) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.04) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.18
Practice expense RVU	6.42
Malpractice RVU	0.44
Total RVU	9.04
Medicare national rate	$301.94
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	$301.94
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 25530 get rejected.

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

Upcoding to 25535 challenged when documentation doesn't clearly state manipulation was absent
Billing a same-day E/M without modifier 25, causing the visit to bundle into the fracture care global
Incorrect code selection when both radius and ulna are fractured — should be 25560, not 25530
Missing or vague imaging documentation to support conservative treatment decision
Applying 25530 when the operative note describes even minor repositioning, which requires 25535

Frequently asked questions

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

01What is the difference between CPT 25530 and 25535?

25530 is for closed treatment without any manipulation of the fracture fragments. 25535 is used when the physician performs a closed reduction to improve alignment. If you touched the fracture to reposition it, even minimally, 25535 applies. The documentation must make this distinction explicit.

02Can I bill a cast or splint application separately when billing 25530?

The fracture care code includes the initial application of the immobilization device. You can bill supply codes (Q codes) for the casting or splinting materials separately on top of the procedure payment, but the application service itself is bundled into 25530.

03What global period applies to 25530, and what does it include?

25530 carries a 90-day global period. Routine follow-up visits, removal of immobilization, and standard post-fracture monitoring are all included. Bill unrelated E/M services during that window with modifier 24. If the patient subsequently needs surgery, attach modifier 57 to the pre-surgical E/M.

04When should I use modifier 57 versus modifier 25 with 25530?

Use modifier 25 on a same-day E/M when a separately identifiable evaluation was performed before the decision to treat the fracture — for example, an ED evaluation. Use modifier 57 on an E/M when the decision is made to proceed with a major surgical procedure (90-day global) on the day before or the day of surgery.

05Can 25530 be billed if both the radius and ulna are fractured?

No. When both forearm bones are fractured, use 25560 (without manipulation) or 25565 (with manipulation). CPT 25530 is specific to an isolated ulnar shaft fracture. Billing 25530 for a both-bone forearm fracture is incorrect code selection and will not accurately reflect the work performed.

06Is modifier 50 appropriate for 25530?

Bilateral ulnar shaft fractures are anatomically uncommon, but if both forearms are independently injured and treated in the same encounter, modifier 50 can be appended. Payer policies on bilateral payment for paired long bones vary — confirm with the specific payer 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 from dictation: fracture site (ulnar shaft, not distal or proximal), explicit confirmation that no manipulation was performed, immobilization type applied, pre-treatment radiographic alignment, and neurovascular exam findings. This prevents the most common audit flag — ambiguous or missing language about whether reduction was attempted — which triggers downcoding challenges or upcoding audits between 25530 and 25535.

See how Mira captures CPT 25530 documentation