Closed treatment of a distal radius fracture (such as Colles or Smith type) or epiphyseal separation, with manipulation; includes closed treatment of an associated ulnar styloid fracture when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $634.62
Total RVUs: 19
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingMdclarityPayerpriceAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture type and classification (e.g., Colles, Smith, intra-articular vs. extra-articular) with laterality
Pre- and post-reduction imaging findings, including alignment and angulation measurements
Description of the manipulation/reduction maneuver performed, including anesthesia or sedation used
Immobilization method applied post-reduction (e.g., sugar-tong splint, short-arm cast) and position of immobilization
Notation of associated ulnar styloid fracture if present and treated concurrently
Fluoroscopic or radiographic confirmation of reduction adequacy documented in the procedure note

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 52 Reduced services 57 Decision for surgery 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 25605 covers closed reduction of a distal radius fracture — the most common fracture type seen in orthopedic and emergency settings. The defining element is manipulation: the physician physically reduces the fracture fragment under anesthesia or sedation, then immobilizes the wrist with a cast or splint. If the ulnar styloid is also fractured, treating it closed is bundled — no separate code. Use 25600 only when no manipulation is performed.

The 90-day global period runs from the date of service. It bundles all routine post-op visits, cast changes, and fracture checks through day 90. Bill an E/M during the global only with modifier 24 (unrelated condition) or modifier 25 (same-day significant E/M prior to the procedure decision). If the treating physician hands off surgical care — common in the ED — modifier 54 covers the intraoperative portion; the follow-up physician uses modifier 55.

If closed reduction fails and ORIF is performed the next day (25607 or 25609), that staged procedure bills with modifier 58. 25605 is bundled as a column-2 code under 25607, 25608, and 25609 — meaning if you ultimately perform open fixation, 25605 does not stack. Document the fracture type, displacement characteristics, reduction maneuver performed, post-reduction alignment confirmed on fluoroscopy, and the immobilization method applied.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.09
Practice expense RVU	11.54
Malpractice RVU	1.37
Total RVU	19
Medicare national rate	$634.62
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	$634.62
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 25605 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier, triggering edit or payer reject
Bundling conflict when 25605 is billed same-day as 25607, 25608, or 25609 without a modifier and clinical justification for separate staging
E/M billed same-day without modifier 25, denied as included in the fracture care package
Global period violation — post-op visit billed without modifier 24 or 79 during the 90-day window
Lack of documented pre-reduction and post-reduction imaging to support medical necessity of manipulation

Frequently asked questions

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

01What is the difference between 25600 and 25605?

25600 is closed treatment without manipulation — the fracture is immobilized as-is. 25605 requires that the physician physically reduces the fracture. The distinction must be explicit in the procedure note; fluoroscopic confirmation of reduction supports 25605.

02Can I bill an E/M on the same day as 25605?

Yes, but only with modifier 25 on the E/M. The E/M must be a significant, separately identifiable service beyond the decision to treat the fracture — document the history, exam, and medical decision-making independently in the note.

03If closed reduction fails and I perform ORIF the next day, how do I bill?

Bill 25605 for the closed reduction on day one. Bill the open fixation code (25607, 25608, or 25609, depending on the technique) with modifier 58 for the staged procedure the following day. Do not stack 25605 with the open code on the same date.

04Does 25605 cover treatment of an associated ulnar styloid fracture?

Yes. Closed treatment of the ulnar styloid is bundled into 25605 when performed at the same session. No separate code is appropriate for the ulnar styloid in that scenario.

05How do I bill when the ED physician reduces the fracture but a different physician handles follow-up?

The treating ED or urgent care physician bills 25605 with modifier 54 (surgical care only). The follow-up physician bills 25605 with modifier 55 (postoperative management only). Both providers should document their respective roles clearly.

06What happens to 25605 during the 90-day global period if the patient needs ORIF?

A return to the OR for open fixation related to the same fracture bills with modifier 78 (unplanned return, related procedure). If the surgery was already planned as a staged procedure from the start, use modifier 58 instead. Modifier 78 applies when the return was not anticipated at the time of the original reduction.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fracture type and pattern (Colles, Smith, intra-articular vs. extra-articular), laterality, pre- and post-reduction alignment from fluoroscopy, the specific reduction maneuver performed, sedation or anesthesia used, presence of an ulnar styloid fracture, and the immobilization device and wrist position applied. This prevents the two most common audit flags: operative notes that omit post-reduction imaging confirmation and documentation that fails to distinguish manipulation (25605) from no-manipulation treatment (25600).

See how Mira captures CPT 25605 documentation