Open treatment of an extra-articular distal radial fracture or epiphyseal separation with internal fixation using wires, screws, or pins.

Verified May 8, 2026 · 7 sources ↓

Medicare: $697.41
Total RVUs: 20.88
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHMdclarityPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must explicitly state the fracture is extra-articular — 'distal radius fracture' alone is insufficient to select 25607 over 25608 or 25609.
Specify the surgical approach by name (e.g., volar FCR approach, dorsal approach) — notes that reference only 'standard approach' are audit targets.
Document all internal fixation hardware used, including type (plate, K-wire, screw) and placement, to justify open treatment over percutaneous fixation.
For pediatric cases involving epiphyseal separation, document Salter-Harris classification or equivalent fracture characterization.
Record fluoroscopic confirmation of reduction intraoperatively — this is inherent to the procedure and not separately billable but supports medical necessity.
If modifier 22 is appended, the operative note must quantify the additional work and explain why complexity exceeded typical expectations for this procedure.

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 51 Multiple procedures 52 Reduced services 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 AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25607 covers open surgical repair of a distal radius fracture or epiphyseal separation that does not extend into the radiocarpal joint — the extra-articular distinction is the critical selector between this code and 25608/25609. The surgeon opens the wrist, reduces the fracture, and secures the distal radius with internal fixation hardware (typically a volar locked plate, though K-wires or screws also qualify). NCCI bundles 25606 (percutaneous skeletal fixation) into 25607, so if the operative note documents both open treatment and percutaneous pinning, bill only 25607.

Most surgically treated distal radius fractures in adults are intra-articular — meaning 25607 is used less frequently than 25608 or 25609 for that population. Extra-articular fractures requiring ORIF appear more often in pediatric patients with epiphyseal separations. If the operative note or diagnosis does not explicitly state intra- versus extra-articular, query the surgeon before coding — a wrong selection here is a coding error, not just a gray area.

The 90-day global period covers the surgery day, the day-before preoperative visit, and all routine follow-up through day 90. Post-op visits unrelated to the fracture need modifier 24. A planned staged procedure in the global window uses modifier 58; an unplanned return for a related complication uses modifier 78; an unrelated procedure in the global period uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.32
Practice expense RVU	9.68
Malpractice RVU	1.88
Total RVU	20.88
Medicare national rate	$697.41
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	$697.41
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,970.99

Common denial reasons

The recurring reasons claims for CPT 25607 get rejected.

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

Upcoding to 25608 or 25609 when documentation does not confirm intra-articular extension — or downcoding 25607 when the note is ambiguous about articular involvement.
Billing 25606 alongside 25607 — NCCI bundles percutaneous fixation into the open treatment code with no modifier override available.
Missing or ambiguous extra-articular designation in the operative note, triggering payer requests for records or outright denial pending documentation.
Post-op E/M services billed without modifier 24 during the 90-day global period when the visit is unrelated to the fracture repair.
Laterality not appended — omitting LT or RT on a unilateral procedure is a common clean-claim failure at many payers.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 25607 from 25608 and 25609?

Articular involvement. 25607 is extra-articular — the fracture line does not enter the radiocarpal joint. 25608 covers a 2-part intra-articular fracture; 25609 covers 3 or more intra-articular fragments. The operative note must explicitly state extra-articular to support 25607.

02Can I bill 25606 and 25607 together when the surgeon used both open and percutaneous techniques?

No. NCCI bundles 25606 into 25607 without a modifier override. When the note documents both open treatment and percutaneous pinning, bill only 25607.

03Is 25607 used more often in adults or pediatric patients?

More often in pediatric patients. Most surgically treated adult distal radius fractures are intra-articular, making 25608 or 25609 the correct code. Extra-articular distal radius fractures requiring ORIF appear more frequently in children with epiphyseal separations.

04What is the global period for 25607, and what does it cover?

90-day global. It includes the surgery, the day-before preoperative visit, and all routine post-op care through day 90 — wound checks, suture removal, cast changes, and routine follow-up. Unrelated E/M services in that window require modifier 24.

05When is modifier 22 appropriate for 25607?

When the work substantially exceeded the typical effort for an extra-articular distal radius ORIF — for example, severe comminution, prior hardware removal, or extreme obesity significantly complicating the approach. The operative note must quantify the additional time and describe why the case was atypical; modifier 22 without supporting documentation will be denied.

06Do I need LT or RT with 25607?

Most commercial payers and MACs require laterality modifiers for unilateral upper-extremity procedures. Omitting LT or RT is a common clean-claim failure. Append the appropriate laterality modifier on every claim.

07How does 25607 code when the surgeon also repairs an ulnar styloid fracture?

Closed treatment of an associated ulnar styloid fracture is included in the distal radius fracture codes — do not bill a separate fracture code for the ulnar styloid when it is treated in the same operative session as the distal radius ORIF.

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 classification (extra-articular vs. intra-articular), surgical approach by name, fixation hardware type and placement, and intraoperative fluoroscopic reduction confirmation directly from dictation. That prevents the most common audit flag for this code family — an operative note that fails to distinguish 25607 from 25608 or 25609 — and eliminates the back-and-forth surgeon query that delays billing.

See how Mira captures CPT 25607 documentation