Open surgical treatment of an ulnar shaft fracture with internal fixation when performed — plate, screws, intramedullary rod, or other hardware as indicated.

Verified May 8, 2026 · 7 sources ↓

Medicare: $594.87
Work RVU: 7.74
Global, days: 90
Region: Wrist

Drawn from CMSAAPCCgsmedicareHhsEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm fracture location is the ulnar shaft — not the distal ulna, ulnar styloid, or radial shaft
Specify internal fixation hardware used (plate and screws, intramedullary nail, etc.) or document why fixation was not placed
State laterality explicitly (left or right forearm) in both the operative note and the impression
Document the surgical approach, incision placement, and reduction technique — 'standard approach' flags audits
Record pre-operative imaging (X-ray or CT) confirming shaft-level ulnar fracture with diagnosis code to match
If modifier 22 is appended, quantify the added complexity — comminution, soft-tissue compromise, revision scenario, or extended operative time with comparison to typical

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25545 covers open treatment of an isolated ulnar shaft fracture, including internal fixation when used. The surgeon incises down to the fracture site, reduces the bone under direct visualization, and stabilizes it with hardware — typically a plate and screws or an intramedullary device. The code captures the entire operative episode: reduction, fixation, and wound closure.

This code carries a 90-day global period, meaning all routine follow-up, dressing changes, and fracture checks through day 90 are bundled. Any E/M on the day of surgery for a separate, distinct problem needs modifier 25. A pre-operative E/M decision visit requires modifier 57, not 25, because the global is major (90-day). Always append LT or RT — laterality is expected and its absence is a common clean-claim failure point.

When both the radius and ulna shaft are treated open in the same session, 25545 is not the right code. Use 25574 (radius or ulna fixed) or 25575 (both fixed) instead. Billing 25545 alongside 25574 or 25575 for the same forearm on the same date will trigger an NCCI bundle conflict.

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 (7.74) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.81) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.74
Practice expense RVU	8.51
Malpractice RVU	1.56
Total RVU	17.81
Medicare national rate	$594.87
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	$594.87
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,653.00

Common denial reasons

The recurring reasons claims for CPT 25545 get rejected.

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

Missing LT or RT modifier — many payers auto-deny laterality-sensitive MSK codes without a side indicator
Diagnosis code maps to distal ulna or ulnar styloid fracture instead of ulnar shaft, creating a CPT-ICD mismatch
25545 billed same-day as 25574 or 25575 without separate-site justification — NCCI bundles same-forearm open ulnar and combined forearm codes
E/M billed same-day without modifier 25, triggering a global period denial when the visit is integral to the fracture decision
Pre-op decision E/M coded with modifier 25 instead of modifier 57 — major global requires 57 for the qualifying E/M
HOPD claims missing a required device HCPCS code when fixation hardware was placed — CGS device-intensive edit returns the claim

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01When does 25545 apply versus 25574 or 25575?

25545 is for an isolated ulnar shaft fracture treated open. If you're also treating the radius shaft open in the same session, use 25574 (fixation of the radius or ulna) or 25575 (fixation of both). Don't stack 25545 with either of those codes for the same forearm.

02Is internal fixation required to bill 25545?

No. The code language includes internal fixation 'when performed,' meaning open treatment without hardware still maps here. Document the reason fixation was not placed — fracture pattern, bone quality, or surgeon judgment — to support the coding decision.

03Which modifier covers the pre-op decision E/M for this procedure?

Modifier 57. Because 25545 carries a 90-day global (major surgery), a same-day or day-before E/M that drove the decision to operate needs modifier 57, not 25. Using 25 on that visit is a common coding error that can trigger a compliance flag.

04Do you need to append LT or RT every time?

Yes. Most payers — including Medicare contractors — expect laterality on extremity fracture codes. A claim without LT or RT will deny or pend for review. Append the appropriate modifier on every claim, including resubmissions.

05How does the 90-day global affect post-op billing?

Routine fracture checks, cast or splint management, suture removal, and office visits related to the ulnar fracture are all bundled through day 90. To bill a same-period visit for a truly unrelated problem, append modifier 24 to the E/M and document the unrelated diagnosis clearly.

06Can 25545 and 25530 or 25535 be billed together if staged treatment was required?

Only if performed on different dates as planned staged procedures, in which case modifier 58 applies to the open procedure. Billing closed treatment and open treatment on the same date for the same fracture is not supportable — document the timeline and staging rationale if conversion from closed to open occurred across two separate operative sessions.

Sources & references

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

Mira Scribe

Mira's AI scribe captures fracture location (shaft vs. distal ulna vs. styloid), laterality, fixation hardware name and configuration, surgical approach, and reduction method directly from dictation. That specificity locks the operative note to CPT 25545 rather than a neighboring code, supports modifier 22 if complexity warrants it, and prevents the CPT-ICD mismatch denials that result when the diagnosis defaults to a non-shaft ulnar fracture code.

See how Mira captures CPT 25545 documentation