Closed treatment of both-bone forearm fractures (radius and ulna shafts together) without any manual realignment of the bone fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $332.00
Work RVU: 2.53
Global, days: 90
Region: Wrist

Drawn from CMSAAPCAaoms

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray) confirming fractures of both the radial and ulnar shafts, with laterality documented
Explicit statement that no manipulation (reduction) was performed
Type of immobilization applied — splint, cast, or other device — with position of the forearm noted
Clinical rationale for closed treatment without manipulation (e.g., acceptable alignment, patient factors)
Laterality clearly documented — left or right forearm — matching the modifier billed
Plan for follow-up imaging to monitor healing during the global period

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 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 6 cited references ↓

CPT 25560 covers non-surgical management of simultaneous radial and ulnar shaft fractures where the treating physician elects not to manipulate the fracture fragments. The forearm is immobilized — typically with a cast or splint — and the fracture is allowed to heal in its current position. No reduction is attempted. This is distinct from 25565, which requires manipulation, and from 25574/25575, which are open treatment codes.

The 90-day global period means all routine follow-up visits, cast changes, and monitoring X-ray interpretations through day 90 are bundled. Any E/M service on the day of or just before the fracture care decision requires modifier 57 (since this is a major surgery global). LT or RT is required to indicate which forearm is involved. If only one bone required treatment and the other was separately addressed, code selection and documentation must reflect that distinction — 25560 is specifically for simultaneous both-bone fractures treated without manipulation.

For concurrent procedures not bundled into the fracture care — such as external fixator application for an associated open injury — append modifier 51. NCCI edits govern what can be unbundled; check the NCCI policy manual before billing adjunct codes on the same date.

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 (2.53) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.94) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.53
Practice expense RVU	6.9
Malpractice RVU	0.51
Total RVU	9.94
Medicare national rate	$332.00
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	$332.00
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 25560 get rejected.

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

Missing laterality modifier (LT or RT) required by most MACs and commercial payers
Billing a separate E/M on the day of fracture care without modifier 57 on the E/M, triggering a global period denial
Code mismatch — billing 25560 when documentation describes a single-bone fracture or when manipulation was actually performed (should be 25565)
Duplicate claim or overlapping global period when a subsequent encounter is billed as a new fracture service rather than a global follow-up
Missing or insufficient X-ray documentation to confirm both-bone shaft involvement

Frequently asked questions

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

01What is the difference between 25560 and 25565?

25560 is used when no manipulation is performed — the fracture is immobilized as-is. 25565 applies when the physician manually reduces the fracture fragments. The documentation must explicitly state whether manipulation occurred; don't let operative or ED notes be ambiguous on this point.

02Can I bill 25560 if only one bone (radius or ulna) was fractured?

No. 25560 is specifically for simultaneous fractures of both the radial and ulnar shafts. If only the ulna shaft is fractured without manipulation, use 25530. If only the radius shaft is involved, see 25600-series codes based on the fracture location.

03Do I need modifier LT or RT on 25560?

Yes. Append LT or RT to indicate which forearm was treated. Most MACs and commercial payers will deny or suspend claims for laterality-dependent fracture codes missing this modifier.

04What modifier goes on the E/M if the physician sees the patient and decides to treat the fracture same day?

Use modifier 57 on the E/M. Because 25560 carries a 90-day (major) global period, modifier 57 — not 25 — is correct for the presurgical decision-making visit. Modifier 25 is reserved for procedures with 0- or 10-day globals.

05Can I separately bill for casting or splinting with 25560?

No. Application of the initial cast or splint is included in the fracture care code. Subsequent cast changes during the 90-day global are also bundled. Only a cast change performed by a different provider, or one clearly outside the global period, may be separately reportable.

06What if the fracture requires an external fixator for an associated open injury?

External fixator application (e.g., 20690 for a uniplane unilateral system) is not bundled into 25560 and may be reported separately. Append modifier 51 to the add-on procedure. Confirm NCCI edits before submitting to ensure no column 1/column 2 conflict exists.

07Is 25560 subject to SNF consolidated billing?

Yes. CMS includes 25560 in the SNF consolidated billing HCPCS list. If the patient is in a Part A SNF stay, the MAC will bundle this service into the SNF PPS payment and separate Part B billing is not permitted.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture laterality, both-bone involvement (radius and ulna shaft), the absence of manipulation, and the immobilization method from the physician's dictation. This prevents the most common denial scenario for 25560 — missing laterality and documentation that conflates 25560 with 25565 by vaguely describing 'fracture reduction' when none occurred.

See how Mira captures CPT 25560 documentation