Closed treatment of an ulnar shaft fracture with manipulation — no incision, fracture reduced by hand.

Verified May 8, 2026 · 5 sources ↓

Medicare: $548.11
Work RVU: 5.23
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit statement that manipulation was performed — absence defaults to 25530
Laterality documented (left vs. right forearm)
Fracture location confirmed as ulnar shaft, not distal ulna or ulnar styloid
Pre- and post-reduction radiographs or fluoroscopy findings referenced in the note
Immobilization type and application documented (cast, splint, brace)
Clinical indication for closed vs. open approach, especially if displacement was significant

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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 5 cited references ↓

25535 covers closed (non-operative) treatment of a fracture of the ulnar shaft that requires manual manipulation to achieve acceptable alignment. The physician reduces the fracture without making an incision, then applies a cast or splint to maintain position. This code sits between 25530 (same fracture, no manipulation needed) and 25545 (open treatment with internal fixation) — choosing the right one hinges entirely on whether manipulation was performed and documented.

The 90-day global period starts on the date of the procedure. It includes the day-before evaluation, the reduction itself, and all routine follow-up visits, cast changes, and imaging reviews through day 90. Any E/M for an unrelated problem during that window requires modifier 24. A pre-procedure E/M on the same day the reduction is performed requires modifier 57 (major global) — not modifier 25, which applies to minor global procedures.

Laterality is required — append LT or RT. If both forearms are treated in the same session (uncommon but possible), use modifier 50. When additional services such as debridement are performed and are not bundled, append modifier 51 to the secondary code.

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 (5.23) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.23
Practice expense RVU	10.1
Malpractice RVU	1.08
Total RVU	16.41
Medicare national rate	$548.11
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	$548.11
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 25535 get rejected.

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

Missing documentation of manipulation — payer downcodes to 25530
Laterality modifier (LT/RT) absent, triggering claim edit or rejection
Wrong ICD-10 fracture code — specificity required for shaft location, laterality, and episode of care (initial vs. subsequent)
E/M billed same day without modifier 57, causing global period bundling denial
Billing 25535 when open reduction was actually performed — correct code is 25545

Frequently asked questions

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

01What's the difference between 25530 and 25535?

Manipulation. 25530 is closed treatment without manipulation — fracture is in acceptable position as-is. 25535 requires the physician to physically reduce the fracture. If your note doesn't say manipulation was performed, the claim should be 25530.

02Which E/M modifier applies when I see the patient in the office and perform the reduction the same day?

Modifier 57. 25535 carries a 90-day (major) global period, so any decision-for-surgery E/M on the day of or day before the procedure takes modifier 57. Modifier 25 is for procedures with a 0- or 10-day global.

03Can I bill separately for the cast application?

Not for the initial cast or splint — application is included in the fracture care code. Subsequent cast changes during the 90-day global are also bundled unless the patient presents for an unrelated issue.

04When should I use modifier 22 with 25535?

When the reduction required substantially greater work than typical — for example, an unstable, highly comminuted fracture requiring extended fluoroscopy and multiple reduction attempts. Document the additional time and complexity explicitly; payers require medical record support before paying the upcharge.

05If the fracture fails closed treatment and I take the patient to the OR for open fixation, how do I code the return surgery?

Use 25545 with modifier 58 — staged or related procedure during the postoperative period. Modifier 78 would apply only if the return was an unplanned procedure. Planned conversion from closed to open treatment is a 58.

06Is 25535 subject to SNF consolidated billing?

Yes. CMS includes 25535 in the SNF PPS consolidated billing list. When a Medicare beneficiary is in a Part A SNF stay, payment for this service is bundled into the SNF per diem — you cannot bill the physician fee schedule separately for that date of service.

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 manipulation statement, laterality, fracture shaft location, reduction technique, post-reduction alignment, and immobilization type directly from dictation. That prevents the most common denial: a claim landing as 25530 because 'with manipulation' was never explicit in the note.

See how Mira captures CPT 25535 documentation