Open treatment of a distal radial intra-articular fracture or epiphyseal separation with internal fixation of exactly 2 fragments.

Verified May 8, 2026 · 7 sources ↓

Medicare: $771.89
Total RVUs: 23.11
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityPayerpriceTdi

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm intra-articular extension of the fracture — extra-articular injuries map to 25607, not 25608
Explicitly document the number of articular fragments fixed (must be 2 to support 25608; 3+ maps to 25609)
Specify the fixation construct used (plate, screws, K-wires, or combination) and implant details
Record laterality (left vs. right) in the operative note and on the claim
Document fluoroscopic confirmation of reduction and fixation intraoperatively
Include pre-op imaging (X-ray or CT) that characterizes the fracture pattern and fragment count
Note any concomitant ulnar styloid fracture treatment — if addressed, document whether it is included or separately billable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 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 25608 covers open reduction and internal fixation of a distal radius fracture that extends into the joint surface, specifically when 2 articular fragments are fixed. The intra-articular designation is the critical distinction from 25607, which covers extra-articular open treatment. Fragment count drives code selection across the 25607–25609 family: 25607 is extra-articular, 25608 is intra-articular with 2 fragments, and 25609 is intra-articular with 3 or more fragments. Upcoding to 25609 without documented fragment count is a consistent audit trigger.

The 90-day global period covers all routine post-op visits, wound care, cast changes, and hardware checks through day 90. Staged procedures during the global — such as hardware removal or tenolysis — require modifier 58 if planned and related. Unrelated procedures in the same window need modifier 79. E/M visits for a separate problem during the global require modifier 24.

This code is performed across hand surgery, orthopedic surgery, and plastic/reconstructive surgery. Fluoroscopy used intraoperatively is integral to the open fixation and is not separately billable. Nerve block billing (e.g., regional anesthesia) was the subject of a documented Texas dispute in which a payer denied a separately billed block as bundled to 25608; document medical necessity clearly if billing ancillary services on the same date.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.79
Practice expense RVU	10.15
Malpractice RVU	2.17
Total RVU	23.11
Medicare national rate	$771.89
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	$771.89
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,980.54

Common denial reasons

The recurring reasons claims for CPT 25608 get rejected.

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

Fragment count missing or ambiguous in operative note — payer downcodes to 25607 or requests medical records
Intra-articular extension not documented, resulting in denial or downcode to extra-articular code 25607
Fluoroscopy billed separately (e.g., 77002) when it is integral to the open fixation procedure
Laterality modifier absent — claims without LT or RT are rejected by many payers
Bundling denial when a separately billed nerve block lacks documentation of distinct medical necessity
Upcoding allegation when 25609 is billed but only 2 fragments are documented — audit risk for the entire claim

Frequently asked questions

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

01What's the difference between 25607, 25608, and 25609?

25607 is open treatment of an extra-articular distal radius fracture. 25608 is open treatment of an intra-articular fracture with fixation of 2 fragments. 25609 is intra-articular with 3 or more fragments. The fracture pattern and fragment count — not the implant type — determine which code applies.

02Can I bill fluoroscopy separately when performing 25608?

No. Intraoperative fluoroscopy is integral to open fixation of a distal radius fracture and cannot be billed separately when performed as part of 25608.

03Do I need a laterality modifier on 25608?

Yes. Append LT or RT on every claim. Most payers reject or pend claims for laterality-sensitive wrist procedures submitted without a side indicator.

04If the surgeon also treats an ulnar styloid fracture at the same session, can that be billed separately?

Closed treatment of an ulnar styloid fracture is generally considered included when documented as part of the same distal radius injury encounter. If the ulnar-side work was open and distinct, document the separate anatomy and apply modifier 59 or 51 as appropriate — but expect scrutiny.

05What modifier applies if the same surgeon performs a staged hardware removal during the 90-day global?

Modifier 58 applies for a planned or staged related procedure performed by the same surgeon during the post-op period. Modifier 78 covers an unplanned return to the OR for a complication related to the original procedure.

06Can 25608 and 25609 be billed together for bilateral fractures?

If both wrists are treated at the same session with different fracture complexity, bill each side with the appropriate code and LT/RT modifiers. Modifier 50 applies only when the identical procedure is performed bilaterally. Different codes on different sides should be billed as separate line items with laterality modifiers.

07What ICD-10 diagnosis codes pair with 25608?

Intra-articular distal radius fractures map to S52.50– through S52.57– series codes, with seventh-character extensions indicating initial encounter (B or C for open fractures), subsequent encounter, or sequela. Use the correct episode-of-care character — initial vs. subsequent — to match the visit type.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures intra-articular fracture characterization, exact fragment count, fixation construct, and laterality directly from the surgeon's dictation. It flags operative notes that state 'ORIF distal radius' without specifying articular involvement or fragment count — the two documentation gaps most likely to trigger a downcode to 25607 or an audit request for records.

See how Mira captures CPT 25608 documentation