Open treatment of both-bone forearm fractures — radius and ulna shaft — with internal fixation applied to each bone when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $845.71
Total RVUs: 25.32
Global, days: 90
Region: Wrist

Drawn from CMSNIHAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify both the radius AND ulna shaft as fracture sites — a note addressing only one bone does not support 25575.
Document the fixation method used on each bone (e.g., plate and screws, IM nail) — 'internal fixation as appropriate' is an audit flag.
Record the surgical approach by name and incision location for each bone; a generic 'standard approach' notation invites downcoding review.
Pre-op imaging (X-ray or CT) confirming diaphyseal fracture of both bones must be present in the record.
If modifier 22 is appended, the operative note must explicitly describe the factors that increased complexity — comminution, prior hardware, failed closed treatment, or other named circumstances.
Anesthesia type and patient positioning documented in the operative report to support facility billing.

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 58 Staged or related 59 Distinct service 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 25575 covers open surgical treatment of simultaneous radius and ulna shaft fractures, with internal fixation of both bones when performed. The surgeon incises to expose both fracture sites, reduces the fragments, and stabilizes each bone — typically with plate-and-screw constructs or intramedullary devices. Both bones must be addressed; if only one shaft is treated open with fixation, see 25515 (radius) or 25545 (ulna) instead.

The 90-day global period means the operative session, the day-before visit, and all routine post-op care through day 90 are bundled into the single payment. Bill unrelated problems seen in that window with modifier 24 on the E/M. A staged procedure — planned at the time of the index surgery — takes modifier 58. An unplanned return to the OR for a complication directly related to the fixation takes modifier 78; an unrelated procedure in the same period takes modifier 79.

Site of service matters significantly here: HOPD and ASC facility payments differ substantially (see the Site of Service comparison table). Assistant surgeon services are reportable with modifier 80. Bilateral same-session fixation is rare given anatomy but would use modifier 50 on a professional claim; ASC claims report LT and RT on separate lines.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.98
Practice expense RVU	10.86
Malpractice RVU	2.48
Total RVU	25.32
Medicare national rate	$845.71
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	$845.71
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,852.90

Common denial reasons

The recurring reasons claims for CPT 25575 get rejected.

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

Billing 25575 when the operative note documents treatment of only one bone — payers downcode to 25515 or 25545.
Missing or inadequate documentation of internal fixation; if hardware application is not explicitly stated, payers may revert to a closed-treatment code.
NCCI bundling conflicts when component codes for individual bone fixation are billed alongside 25575 on the same date.
Modifier 22 appended without operative note language specifically describing the increased complexity — routinely denied without supporting narrative.
Global period violations: billing routine post-op visits without modifier 24 or 25 during the 90-day window.

Frequently asked questions

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

01What is the difference between 25575 and 25560?

25560 is closed treatment of both-bone forearm fractures without manipulation; 25575 is open treatment with internal fixation. If you opened the fracture site and placed hardware, 25575 is correct. Do not bill 25560 on the same date as 25575.

02Can I bill 25515 and 25545 together instead of 25575?

No. When both bones are treated open with fixation in the same session, 25575 is the single correct code. Unbundling into individual bone codes will trigger NCCI edits and likely result in denial of the secondary code.

03Is fluoroscopy separately billable during 25575?

Intraoperative fluoroscopy used to confirm reduction or implant position is generally considered integral to open fracture fixation and is not separately reportable per CMS NCCI guidance. Do not append a fluoroscopy code to 25575.

04When does modifier 22 apply to 25575?

Append modifier 22 when the case required substantially more work than typical — for example, high-grade comminution, retained hardware from a prior fixation requiring removal, or a failed closed reduction attempt requiring conversion. The operative note must name the complicating circumstance; 'difficult case' is not sufficient.

05How should a planned second-stage procedure be billed during the 90-day global?

Use modifier 58 for a staged or more-extensive procedure that was anticipated at the time of the original surgery — for example, a planned bone grafting or hardware exchange. Modifier 58 reopens a new global period. An unplanned return to the OR for a related complication uses modifier 78 instead.

06Can an E/M be billed the same day as 25575?

Only if a significant, separately identifiable evaluation and management service was performed beyond the pre-operative assessment inherent to the procedure. Append modifier 25 to the E/M code. The visit documentation must stand on its own and cannot simply restate the fracture diagnosis leading to surgery.

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-bone involvement, named surgical approach for each incision, fixation construct applied to the radius and to the ulna, and any complicating factors (comminution grade, prior hardware, failed conservative treatment). That specificity prevents downcoding to a single-bone code and gives modifier 22 the documentation it needs to survive audit.

See how Mira captures CPT 25575 documentation