Open treatment of a distal radial intra-articular fracture or epiphyseal separation requiring internal fixation of three or more fragments
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $968.29
- Total RVUs
- 28.99
- Global, days
- 90
- Region
- Wrist
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 confirm the fracture is intra-articular (involving the radiocarpal or DRUJ surface) — extraarticular fractures do not support 25609
- Fragment count of three or more must be explicitly stated in the operative note or supported by pre-op imaging report
- Internal fixation method must be documented (e.g., volar locking plate, dorsal plate, K-wires combined with plate, fragment-specific fixation)
- Imaging — preoperative X-ray or CT — should be referenced in the note and retained in the record to support fragment count
- If additional procedures were performed on the same wrist (e.g., ulna ORIF, DRUJ repair), each must have its own documented indication and technique
- For epiphyseal separation: document patient age and growth plate involvement to support the epiphysis descriptor if used
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 25609 covers open surgical treatment of a distal radius fracture or epiphyseal separation that is intra-articular and involves three or more discrete fragments requiring internal fixation. This is the highest-complexity code in the distal radius open treatment family (25607–25609), distinguished from 25608 (two fragments) by the fragment count. The intra-articular designation is critical — if the fracture line does not involve the radiocarpal or distal radioulnar joint surface, a different code applies.
The 90-day global period bundles all routine post-op care through day 90, including cast changes, hardware checks, and standard therapy referrals. Any visit or procedure unrelated to the fracture repair during that window requires modifier 24 or 79. Concomitant procedures on the same wrist — such as repair of a concurrent distal ulna fracture or DRUJ stabilization — may be separately reportable depending on NCCI edits; modifier 59 or XS may be needed to bypass bundles where clinically appropriate.
This code is performed almost exclusively by hand surgeons, orthopedic surgeons, and plastic/reconstructive surgeons. It is billed in the ASC and HOPD settings at meaningfully different facility rates. The distinction between 25607, 25608, and 25609 hinges entirely on fragment count documented in the operative note — auditors will pull the imaging and compare.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.02 |
| Practice expense RVU | 12.22 |
| Malpractice RVU | 2.75 |
| Total RVU | 28.99 |
| Medicare national rate | $968.29 |
| 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 | $968.29 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,014.28 |
Common denial reasons
The recurring reasons claims for CPT 25609 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Fragment count not documented in operative note — payer downcodes to 25608 or 25607 based on insufficient specificity
- Fracture characterized as extraarticular on imaging but 25609 (intraarticular code) billed — mismatch triggers denial or audit
- Fluoroscopy or imaging guidance billed separately when considered bundled with the open reduction procedure
- Concurrent distal ulna or DRUJ procedure denied as bundled without a modifier 59 or XS to establish distinctness
- Global period violation — post-op E/M billed without modifier 24, triggering automatic denial during the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What's the difference between 25607, 25608, and 25609?
02Can I bill a concurrent distal ulna ORIF separately with 25609?
03Is fluoroscopy separately billable with 25609?
04Which modifier do I use for a same-day E/M when the patient presents to the ER and goes straight to surgery?
05Does laterality need to be reported for 25609?
06When does modifier 22 apply to 25609?
07What happens if a hardware removal or revision is needed within the 90-day global?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/chapter4cptcodes20000-29999final11.pdf
- 03cms.govhttps://www.cms.gov/files/document/r12449cp.pdf
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/25609
- 05findacode.comhttps://www.findacode.com/cpt/25609-cpt-code.html
- 06payerprice.comhttps://payerprice.com/rates/25609-CPT-fee-schedule
Mira AI Scribe
Mira's AI scribe captures the fracture classification (intra-articular), the exact fragment count from intraoperative findings, the fixation construct used (implant type, plate position, supplemental K-wires), and any concurrent procedures with separate indications. This prevents the most common 25609 downcode — an operative note that confirms open reduction but never states three or more fragments explicitly — which auditors exploit to drop the claim to 25608.
See how Mira captures CPT 25609 documentation