Closed treatment of an ulnar styloid fracture without surgical incision, typically managed with cast or splint immobilization.

Verified May 8, 2026 · 6 sources ↓

Medicare: $379.10
Total RVUs: 11.35
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury documented (e.g., fall on outstretched hand)
Radiographic confirmation of ulnar styloid fracture with laterality noted
Description of immobilization applied — cast type, splint, or brace — and materials used
Neurovascular status of the wrist and hand assessed and recorded
Notation that no surgical incision was made (closed treatment confirmed)
Fracture displacement status documented to support closed vs. open decision
Any manipulation performed during the encounter explicitly described

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 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25650 covers closed (non-operative) management of an ulnar styloid fracture — the small bony projection at the distal ulna near the wrist. No incision is made. Treatment typically consists of cast or splint application after clinical and radiographic assessment. The ulnar styloid is a common fracture site when a patient extends the hand to break a fall, and it frequently occurs alongside distal radius fractures.

The 90-day global period means the casting visit, any manipulation performed at that encounter, and all routine follow-up through day 90 are bundled into the single code. If a concurrent distal radius fracture is treated operatively (e.g., 25609), note that NCCI edits bundle 25650 into 25609 — do not report both. When the ulnar styloid fracture is the only injury treated and no open or percutaneous fixation is performed, 25650 is the correct stand-alone code.

Site of service matters here: HOPD and ASC payments differ from the non-facility rate. If the encounter occurs in the emergency department or an outpatient hospital setting, apply the facility payment rules. An E/M service performed at the same encounter to work up an unrelated problem requires modifier 25 appended to the E/M code. If the decision for surgery on a related 90-day global procedure is made the same day, use modifier 57 on the E/M.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.15
Practice expense RVU	7.54
Malpractice RVU	0.66
Total RVU	11.35
Medicare national rate	$379.10
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	$379.10
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 25650 get rejected.

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

Bundling denial when 25650 is billed same-day with 25609 — NCCI includes ulnar styloid treatment in the distal radius ORIF code
Laterality missing — payers require LT or RT to process wrist fracture claims cleanly
E/M billed same-day without modifier 25, triggering automatic bundling with the fracture care code
Upcoding flag when operative note references a concurrent distal radius fracture but only 25650 is submitted without clear documentation that the radius fracture was separately addressed
Global period violation — follow-up visit billed within the 90-day window without modifier 24 or 79 for an unrelated condition

Frequently asked questions

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

01Can I bill 25650 and 25609 together when the patient has both an ulnar styloid fracture and a distal radius fracture treated in the same session?

No. NCCI edits bundle 25650 as a component of 25609 (ORIF distal radius, 3+ fragments). When the distal radius is treated operatively, the ulnar styloid management is considered included. Do not append modifier 59 to override this — the edit reflects standard surgical practice, not an incidental bundling conflict.

02What modifier do I use for a follow-up visit within the 90-day global?

For a visit addressing a condition unrelated to the ulnar styloid fracture, append modifier 24 to the E/M code. For an unrelated procedure performed during the global period, use modifier 79. Do not bill routine fracture follow-up visits separately — they are bundled.

03Is laterality required when billing 25650?

Yes. Append LT or RT. Most commercial payers and Medicare require laterality on wrist and forearm procedure codes. Missing laterality is a clean-claim failure that delays or denies payment.

04Does 25650 require a reduction to be billable, or does casting alone qualify?

Casting or splinting alone is sufficient — 25650 covers closed treatment whether or not manipulation was performed. If the fracture required manipulation, document that explicitly; it supports the medical necessity of the encounter but does not change the code.

05When is modifier 57 appropriate with 25650?

Modifier 57 applies to an E/M service at which the decision for a major (90-day global) surgery is made. Since 25650 itself carries a 90-day global, if you see the patient in the E/M visit and decide that day to proceed with an ORIF of the wrist under a separate 90-day code, append modifier 57 to the E/M. Do not use 57 to unbundle a same-day E/M from the fracture care code — that requires modifier 25.

06What ICD-10 codes pair with 25650?

Common pairings include S62.001A–S62.002A (fracture of distal ulna, right and left, initial encounter) and S52.611A–S52.612A (displaced fracture of ulnar styloid process). Use the seventh character to reflect encounter type: A for initial, D for subsequent, S for sequela. Confirm laterality matches the modifier on the CPT claim.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures mechanism of injury, fracture laterality, displacement status, immobilization type applied, and the explicit statement that treatment was closed (no incision). It also flags when a concurrent distal radius fracture is dictated — alerting the coder to check NCCI bundling rules before billing 25650 alongside any distal radius fracture code. This prevents the most common denial on this code: submitting 25650 with 25609 without recognizing the column-1/column-2 relationship.

See how Mira captures CPT 25650 documentation