Open surgical repair of a fractured ulnar styloid process at the wrist, typically using internal fixation hardware such as pins, wires, screws, or plates to stabilize the bony fragment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $590.86
Work RVU: 7.86
Global, days: 90
Region: Wrist

Drawn from CMSAAPCIcdcodesEatonhand

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 name the specific fixation method used (K-wire, tension band construct, screw, suture anchor) — 'hardware placed' is insufficient for audit defense.
Specify laterality (left or right wrist) in both the operative note and the diagnosis coding; missing laterality is a common claim edit trigger.
Document DRUJ stability assessment (e.g., stress test result, translation measurement) to justify open versus closed approach when payers question medical necessity.
Record fracture displacement or nonunion status preoperatively, including imaging findings, to support the decision for open treatment over percutaneous or closed methods.
If reported alongside a distal radius fracture code, document that the styloid fixation was a separately planned, independently necessary procedure — not incidental to the radius repair.
ICD-10 encounter type (initial vs. subsequent vs. sequela) must match the clinical phase; using a sequela code during active treatment is a flagged coding risk.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 25652 covers open treatment of an ulnar styloid fracture — the small bony projection at the distal end of the ulna near the wrist. The surgeon makes a dorsal-ulnar incision, exposes the fracture site, reduces the fragment, and secures it with hardware (K-wires, tension band, screw, or suture anchor). This is distinct from closed treatment or percutaneous pinning, and is typically chosen when the fragment is displaced, nonunited, or associated with distal radioulnar joint (DRUJ) instability.

The 90-day global period covers the day-before visit, the surgery itself, and all routine postoperative management through day 90 — including cast checks, suture removal, and routine wound care. Separate billing for those services requires modifier 24 or 25. Casting or splinting applied at the time of surgery is bundled per NCCI policy and cannot be billed separately when the surgeon assumes follow-up care.

Ulnar styloid fractures frequently occur alongside distal radius fractures. When 25652 is reported with a distal radius ORIF (e.g., 25607 or 25608), append modifier 51 to the lower-valued code. Document clearly that the styloid fracture required independent open fixation — not simply that it was noted intraoperatively — or the additional code will be denied as incidental.

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 (7.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.69) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.86
Practice expense RVU	8.26
Malpractice RVU	1.57
Total RVU	17.69
Medicare national rate	$590.86
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	$590.86
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,706.79

Common denial reasons

The recurring reasons claims for CPT 25652 get rejected.

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

Bundling denial when billed same-day with a distal radius fracture code without modifier 51, as payers treat the styloid repair as incidental to the radius procedure.
Medical necessity denial when the operative note fails to document displacement, instability, or failed conservative treatment that justifies open surgical intervention.
Laterality mismatch between the CPT claim and the ICD-10 diagnosis code triggers automated edits and suspends payment.
Global period violation when post-op E&M visits are billed without modifier 24, since the 90-day global bundles all routine follow-up by the operating surgeon.
Incorrect encounter-type ICD-10 coding (e.g., sequela code used during active treatment) causes diagnosis-to-procedure mismatch and claim rejection.

Frequently asked questions

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

01Can I bill 25652 alongside a distal radius ORIF on the same day?

Yes, if the ulnar styloid required independent open fixation. Report the lower-valued code with modifier 51. The operative note must document that the styloid fracture was separately addressed — not just noted — or the additional code will be denied as incidental to the radius repair.

02Is casting or splinting separately billable when I perform 25652?

No. Per NCCI policy, casting and splinting applied at the time of fracture treatment are bundled into the fracture code when the surgeon assumes follow-up care. Billing a separate casting code in that scenario will be denied.

03What ICD-10 code supports 25652?

S52.611A (displaced fracture of ulnar styloid, initial encounter) is the primary supporting diagnosis for open treatment. Confirm laterality specificity (right: S52.611A mapped with appropriate 7th character) and that the encounter type matches the clinical phase — active surgical treatment is an initial encounter, not sequela.

04Does the 90-day global period apply to 25652?

Yes. The 90-day global covers the day-before visit, the operative session, and all routine post-op management through day 90. To bill an E&M during that window for an unrelated problem, append modifier 24. For a significant, separately identifiable E&M on the day of surgery, use modifier 25.

05When should modifier 22 be appended to 25652?

Append modifier 22 when the procedure required substantially more work than typical — for example, a nonunited styloid with fibrous tissue requiring debridement, difficult anatomy, or prolonged operative time. Document the specific factors in the operative note; without that support, payers will strip the modifier and reduce payment to the base rate.

06Is 25652 ever appropriate for an ulnar head or shaft fracture?

No. 25652 is specific to the styloid process. Ulnar head and shaft fractures map to different CPT codes. Applying 25652 to a head or shaft fracture is a misrepresentation and an audit risk — verify fracture location on imaging before code selection.

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 surgical approach (dorsal-ulnar incision), fracture displacement status, fixation construct used (K-wire, tension band, screw, or suture anchor), DRUJ stability assessment, and laterality directly from the surgeon's dictation. That structured capture prevents the most common audit flag for 25652 — an operative note that confirms a fracture was seen but doesn't document why open fixation was chosen or what hardware was placed.

See how Mira captures CPT 25652 documentation