Percutaneous skeletal fixation of an ulnar styloid fracture at the wrist, using pins or wires inserted through the skin to stabilize the fracture without open surgical exposure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $473.62
Work RVU: 5.67
Global, days: 90
Region: Wrist

Drawn from CMSAAPCBedrockbillingCgsmedicareAMA

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, direct trauma)
Pre-operative imaging confirming ulnar styloid fracture location and displacement
Operative note specifying percutaneous approach — fracture not visualized, hardware inserted through skin
Type and number of fixation devices used (K-wire, pin, screw) with placement confirmed under imaging guidance
Fluoroscopy or other intraoperative imaging referenced if guidance is separately billed
Post-reduction alignment documented in the operative report or imaging interpretation
If billed with 25606 for concurrent distal radius fracture, operative note must describe distinct fixation work at each fracture site

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 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 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 6 cited references ↓

CPT 25651 describes percutaneous skeletal fixation of an ulnar styloid fracture — a wrist-region fracture most often caused by a FOOSH (fall on outstretched hand) mechanism. In this technique, the fracture fragments are not directly visualized. Instead, the surgeon passes fixation hardware (typically K-wires or pins) percutaneously across the fracture site, most commonly under fluoroscopic guidance, to hold the fragments in stable alignment. This is distinct from closed treatment (no fixation) and open treatment (surgical exposure of the fracture site).

The procedure carries a 90-day global period. All routine follow-up care, cast changes, pin site checks, and hardware removal attributable to this procedure are bundled through day 90. Services unrelated to the fracture during that window require modifier 24 (E/M) or 79 (unrelated procedure). If the same surgeon performs a staged or related procedure during the global, modifier 78 applies.

Ulnar styloid fractures frequently occur alongside distal radius fractures. When a concomitant distal radius fracture is also treated percutaneously on the same date, 25651 and 25606 can be reported together with modifier 59 if documentation clearly supports distinct fixation work at anatomically separate fracture sites. Bundling with imaging guidance codes is payer-variable — confirm fluoroscopy (77002) reportability separately, as NCCI edits govern that pairing.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.67) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.18) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.67
Practice expense RVU	7.38
Malpractice RVU	1.13
Total RVU	14.18
Medicare national rate	$473.62
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	$473.62
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,334.41

Common denial reasons

The recurring reasons claims for CPT 25651 get rejected.

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

Operative note describes open exposure, making 25651 (percutaneous) the wrong code — should be an open fixation code
Bundled denial when billed same-day with 25606 without modifier 59 supporting separate fracture sites
Global period conflict — follow-up E/M billed without modifier 24 during the 90-day post-op window
Diagnosis code mismatch — ICD-10 pointing to distal radius rather than ulnar styloid fracture
Fluoroscopy (77002) denied as bundled when NCCI edit applies and modifier documentation is insufficient

Frequently asked questions

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

01Can 25651 and 25606 be billed together when both the ulnar styloid and distal radius are fixed percutaneously on the same day?

Yes, but only with modifier 59 on the column-2 code, and only when the operative note documents distinct fixation work at each anatomically separate fracture site. Vague language like 'fractures stabilized' won't survive a modifier 59 audit.

02Is fluoroscopy (77002) separately billable with 25651?

It depends on the payer. NCCI edits govern this pairing — check the current PTP edit table for 25651 and 77002 before billing. Some payers bundle imaging guidance into the procedure value; others allow separate reporting with documentation of a distinct guidance service.

03What modifier applies if the same surgeon needs to return to the OR during the 90-day global to address pin loosening or re-fracture related to the original fixation?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the post-op period. Do not use modifier 79, which is reserved for unrelated procedures.

04What is the global period for 25651 and what does it include?

25651 carries a 90-day global period. It covers the day of surgery, all routine follow-up visits, pin site management, cast or splint changes, and hardware removal directly tied to this procedure through post-op day 90.

05Does the type or displacement severity of the ulnar styloid fracture affect which code to use?

No. Per AMA CPT musculoskeletal guidelines (updated 2022), there is no coding correlation between fracture type and treatment code. The code is selected by the treatment method performed — percutaneous fixation — not by fracture classification or displacement grade.

06When is modifier 22 appropriate for 25651?

Modifier 22 applies when the work is substantially greater than typical — for example, severely comminuted fragments requiring multiple passes, unusual patient anatomy, or significantly prolonged operative time. Attach a cover letter with operative time, complexity factors, and a reimbursement request. Without documentation, payers routinely ignore modifier 22 additions.

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 percutaneous approach, hardware type and count, fluoroscopic guidance use, fracture site confirmed as ulnar styloid, and intraoperative alignment findings from surgeon dictation. This prevents the most common audit flag for 25651: operative notes that fail to distinguish percutaneous fixation from open treatment, or that omit confirmation that the fracture fragments were not directly visualized — the defining element separating this code from open fixation alternatives.

See how Mira captures CPT 25651 documentation