Open treatment of both radial and ulnar shaft fractures with internal fixation, when performed, of the radius OR ulna — one bone fixed, both bones fractured.

Verified May 8, 2026 · 5 sources ↓

Medicare: $640.96
Work RVU: 8.58
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHEatonhandAao

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which bone(s) received internal or external fixation — radius, ulna, or both — and document that both shaft fractures were present
Name the fixation method and hardware used (plate, intramedullary nail, external fixator) for the bone that was fixed
Document the laterality (left or right forearm) explicitly in the operative note and diagnosis coding
Record the fracture classification or descriptor (displaced, open, closed, comminuted) to support medical necessity and ICD-10 diagnosis selection
If closed reduction was attempted and converted to open, document the failed attempt and the intraoperative decision to proceed with ORIF
Note any associated neurovascular injury, compartment assessment, or wound findings when debridement or additional procedures were performed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 ↓

25574 covers open reduction with internal fixation (ORIF) of both a radial shaft fracture and an ulnar shaft fracture when only one of the two bones receives fixation at that encounter. The 'both bones forearm fracture' scenario requires careful code selection: 25574 is the correct code when both bones are fractured but fixation is performed on only one; 25575 applies when both bones are openly reduced and internally fixed. This distinction is the most common source of miscoding in forearm fracture billing.

The code carries a 90-day global period. Any E/M performed on the day of or day before surgery that led to the decision to operate requires modifier 57. Laterality modifiers LT or RT are required on all fracture care claims. If a same-session debridement or additional fixation procedure is not bundled into 25574, append modifier 51 to the secondary procedure.

When a closed reduction attempt fails and the surgeon converts to open reduction during the same encounter, bill only the open reduction code — not both. NCCI policy explicitly prohibits billing the failed closed reduction alongside the open procedure for the same bone at the same session.

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 (8.58) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.19) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.58
Practice expense RVU	8.86
Malpractice RVU	1.75
Total RVU	19.19
Medicare national rate	$640.96
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	$640.96
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,158.47

Common denial reasons

The recurring reasons claims for CPT 25574 get rejected.

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

25574 and 25575 billed together for the same forearm — bill 25574 when only one bone is fixed, 25575 when both are fixed; they are mutually exclusive for a single forearm
Missing laterality modifier LT or RT causes claim rejection or edit failure on most payers
Closed reduction code billed alongside 25574 for the same bone at the same encounter — NCCI bundles the failed closed attempt into the open procedure
Modifier 57 omitted on the pre-operative E/M when the decision to operate was made; 90-day global triggers a denial without it
ICD-10 diagnosis code does not reflect both a radial and ulnar shaft fracture, creating a mismatch that flags medical necessity review

Frequently asked questions

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

01What is the difference between 25574 and 25575?

25574 is used when both the radius and ulna shaft are fractured but only one bone undergoes open fixation at that encounter. 25575 is used when both bones are openly reduced and internally fixed. Never bill both codes for the same forearm at the same session.

02Do I need a laterality modifier on 25574?

Yes. Append LT for left or RT for right on every forearm fracture claim. Most payers reject or flag claims without laterality on paired-structure codes.

03Which modifier goes on the pre-op E/M when billing 25574?

Use modifier 57 on the E/M when the decision to perform surgery was made. All radial and ulnar shaft ORIF codes carry a 90-day global, making modifier 57 — not 25 — the correct choice for that pre-surgical visit.

04Can I bill a closed reduction code if the surgeon attempted closed reduction and then converted to open?

No. Per NCCI policy, if a closed reduction is attempted and the surgeon converts to open reduction at the same encounter, bill only the more extensive open reduction code. The failed closed attempt is not separately billable.

05When would modifier 22 apply to 25574?

Modifier 22 applies when the work is substantially greater than typical — for example, severely comminuted fractures requiring prolonged fixation, significant vascular repair, or extensive intraoperative complexity. Attach a cover letter documenting the increased time and difficulty; payers will not increase payment without supporting documentation.

06Is 25574 billable in an ASC setting?

Yes. 25574 has an established ASC payment rate. See the site-of-service comparison on this page for the current ASC versus HOPD figures per the CMS Physician Fee Schedule 2026.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific bones fractured, which bone received fixation and by what method, the laterality of the injury, and whether a prior closed reduction attempt was made and failed intraoperatively. That documentation prevents the most common audit flag: an operative note that says both bones were fractured but doesn't clearly state which one was actually fixed, leaving coders unable to distinguish 25574 from 25575.

See how Mira captures CPT 25574 documentation