Closed treatment of both-bone forearm fractures (radius and ulnar shaft) requiring manipulation to achieve acceptable alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $623.59
Total RVUs: 18.67
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodePayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm fracture involves BOTH the radial shaft and the ulnar shaft — single-bone fractures map to different codes.
Document that manipulation (active reduction) was performed; describe technique, anesthesia/sedation used, and post-reduction alignment.
Pre- and post-reduction radiographs with the interpreting physician's findings on alignment, angulation, and displacement.
Type of immobilization applied (sugar-tong splint, long-arm cast, short-arm cast) and the position of immobilization.
Patient consent notation and any complications or unusual circumstances encountered during reduction.
For same-day E/M: document a separately identifiable medical decision beyond the fracture management itself to support modifier 25.

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 76 Repeat, same physician 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 25565 covers closed (non-operative) treatment of fractures involving both the radial shaft and the ulnar shaft when manipulation is required. This distinguishes it from the without-manipulation counterpart: the treating provider must actively reduce the fracture, typically under sedation or regional block, before applying a cast or splint. Both bones must be fractured — if only the ulna is manipulated, see 25535; if only the radius, see 25600 or 25605.

The 90-day global period covers all routine follow-up visits, cast changes, and radiographic checks related to the fracture through day 90. A same-day E/M is separately billable only with modifier 25, and only if it reflects a separately identifiable, documented decision — not the fracture management itself. Return visits during the global period for unrelated problems require modifier 24.

This code is commonly billed from the emergency department or an outpatient hospital setting, which explains the site-of-service differential between HOPD and ASC payment rates. When a reduction attempt fails and an open procedure (25574 or 25575) is subsequently required, the intraoperative conversion is reported with modifier 22 or a more specific code depending on timing — do not re-report 25565 with modifier 76 unless an independent, repeated closed reduction is performed on a separate 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	5.7
Practice expense RVU	11.66
Malpractice RVU	1.31
Total RVU	18.67
Medicare national rate	$623.59
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	$623.59
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25565 get rejected.

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

Unbundling error: billing a same-day E/M without modifier 25 when the visit was solely for fracture evaluation and casting.
Wrong code for single-bone fracture: ulna-only maps to 25535; radius-only distal fracture maps to 25600/25605.
Global period violation: billing a routine follow-up visit within the 90-day global without modifier 24, flagged as duplicate or included service.
Missing post-reduction radiograph documentation, causing payers to deny manipulation as unsupported.
Laterality not specified: many payers require LT or RT modifier; claims with no laterality modifier are rejected or returned.

Frequently asked questions

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

01Can I bill 25565 twice if I had to re-manipulate the fracture on a separate visit?

Yes, if a true separate closed reduction is performed on a distinct date of service within the global period, report 25565 again with modifier 76 (repeat procedure by same physician). Document the clinical rationale — typically loss of reduction confirmed on follow-up imaging.

02What's the difference between 25565 and 25575?

25565 is closed treatment with manipulation — no surgical incision. 25575 is open treatment of both-bone forearm shaft fractures requiring internal fixation. If you convert a closed attempt to an open procedure in the same session, report the open code only.

03Do I need modifier LT or RT for 25565?

Most payers require laterality. Apply LT or RT routinely. Omitting laterality is a common clean-claim failure that delays or denies payment, particularly from commercial payers and Medicare Advantage plans.

04A patient returns within the 90-day global with an unrelated wrist infection. How do I bill the E/M?

Bill the E/M with modifier 24 (unrelated evaluation and management during postoperative period). Document clearly in the note that the encounter is for a problem unrelated to the fracture management.

05Is an assistant surgeon billable for 25565?

Generally no — closed fracture manipulation rarely meets payer criteria for a necessary assistant surgeon. If you do use one, modifier 80 applies, but expect scrutiny. Confirm with the specific payer's assistant-at-surgery policy before billing.

06Can I separately bill for the casting or splint applied after reduction?

No. The application of the initial cast or splint is included in 25565 and is not separately reportable. Subsequent cast changes during the global period are also bundled unless unusual circumstances justify modifier 22 with supporting documentation.

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 fracture pattern (both radial and ulnar shaft), the reduction technique used, sedation or anesthesia type, post-reduction radiographic alignment findings, and the immobilization method and position applied. That documentation package directly supports medical necessity for the manipulation and defends against the most common denial — missing evidence that an active reduction was performed.

See how Mira captures CPT 25565 documentation