Percutaneous skeletal fixation of a distal radial fracture or epiphyseal separation, performed without open exposure of the fracture site.

Verified May 8, 2026 · 6 sources ↓

Medicare: $641.63
Total RVUs: 19.21
Global, days: 90
Region: Wrist

Drawn from CMSAAPCBedrockbilling

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 is treated percutaneously — no open exposure of the fracture site; any open exposure shifts the code to 25607/25608/25609
Specify intra-articular vs. extra-articular fracture pattern; auditors flag operative notes that omit this distinction
Document fluoroscopic or imaging guidance used intraoperatively for pin placement
Record the number and type of pins or wires placed and their final position confirmed on imaging
If concurrent ulnar styloid or ulnar shaft fracture was treated, document each fracture and its treatment separately
For epiphyseal separation in pediatric patients, document physeal involvement and Salter-Harris classification

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another 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 25606 covers percutaneous pin or wire fixation of a distal radius fracture or epiphyseal separation — the surgeon stabilizes the fracture through the skin using fluoroscopic guidance without opening the fracture site. This is a step up from closed treatment (25600/25605) and a step below open fixation (25607–25609). The percutaneous approach is most common in displaced fractures reducible by closed means that need hardware to hold alignment.

The 25606-vs-25607/25608/25609 decision is the critical coding fork. NCCI bundles 25606 into 25607, so if the operative note documents any open exposure of the fracture site, 25607 (extra-articular) or 25608/25609 (intra-articular) is the correct code — not 25606 with an add-on. Most distal radius fractures requiring surgery in adults are intra-articular, making 25608/25609 the more common open-fixation codes. If the surgeon doesn't specify intra- vs. extra-articular in the dictation, query before submitting.

The global period is 90 days. Routine post-op wrist checks, pin care, and cast changes through day 90 are included. Hardware removal (pin pulls) in the global window is bundled unless it requires a separate OR visit, in which case modifier 78 applies for an unplanned return for a related procedure. Concurrent ulnar styloid fixation (25651) or ulnar styloid percutaneous pinning (25651) on the same wrist is separately reportable with modifier 59 where NCCI edits apply.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.1
Practice expense RVU	9.42
Malpractice RVU	1.69
Total RVU	19.21
Medicare national rate	$641.63
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	$641.63
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25606 get rejected.

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

Upcoding flag: open technique described in operative note triggers NCCI bundle with 25607, causing 25606 denial
Fracture type not specified (intra- vs. extra-articular) — payer requests records and downcodes or denies pending clarification
Concurrent same-wrist procedure (e.g., 25651) billed without modifier 59, triggering NCCI bundling denial
Global period conflict: post-op visit billed without modifier 24 or 25 within the 90-day global window
Bilateral distal radius fractures billed without modifier 50 (or LT/RT pair) — Medicare and most payers require bilateral indicator

Frequently asked questions

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

01When does 25606 get bundled into 25607, and how do I avoid it?

NCCI bundles 25606 into 25607 when both are billed together. If the operative note documents any open exposure of the fracture site, bill 25607 (extra-articular open) or 25608/25609 (intra-articular open) from the start — not 25606 with a modifier. The bundle exists because open fixation includes everything percutaneous fixation does and more.

02Can I bill 25651 for the ulnar styloid on the same day as 25606?

Yes. Percutaneous fixation of a concurrent ulnar styloid fracture (25651) is separately reportable. Apply modifier 59 to 25651 to bypass NCCI bundling edits and document each fracture and its treatment distinctly in the operative note.

03Is 25606 a bilateral code, and how do I bill it for both wrists?

25606 is not inherently bilateral, but CMS and most payers recognize bilateral procedures. For fractures on both wrists treated in the same session, bill with modifier 50, or submit two line items with LT and RT. Medicare requires modifier 50 on a single line; verify your payer's preference before submitting.

04What modifier applies if I need to return to the OR during the 90-day global to remove pins?

Pin removal requiring a separate OR visit during the global period is a related procedure — use modifier 78 (unplanned return to OR for related procedure). Do not use modifier 79; that is for unrelated procedures.

05Should 25606 or 25608/25609 be used for most adult distal radius fractures requiring surgery?

Most distal radius fractures in adults that require operative intervention are intra-articular. If the surgeon opens the fracture site, 25608 (one fragment) or 25609 (two or more fragments) is correct. Reserve 25606 strictly for cases with percutaneous-only fixation, confirmed by an operative note that describes no open exposure.

06Does fluoroscopy need to be billed separately with 25606?

Fluoroscopic guidance used intraoperatively to guide pin placement is generally considered included in 25606 and not separately reportable for the same procedure. Document its use in the operative note. If a distinct fluoroscopic service is performed for a separate procedure on the same date, review NCCI edits before billing independently.

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 surgical approach (percutaneous vs. open), fracture articularity (intra- vs. extra-articular), pin count and placement, fluoroscopic confirmation, and any concurrent ulnar fracture treatment directly from dictation. That specificity prevents the two most common downcodes for this procedure: miscoding percutaneous as open fixation, and losing a separately billable ulnar procedure to an unbundling denial.

See how Mira captures CPT 25606 documentation