{"id":181042,"date":"2026-08-17T08:08:04","date_gmt":"2026-08-17T08:08:04","guid":{"rendered":"https:\/\/pabau.com\/?p=181042"},"modified":"2026-08-17T08:35:13","modified_gmt":"2026-08-17T08:35:13","slug":"cpt-code-25492","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-25492\/","title":{"rendered":"CPT code 25492: Prophylactic bone treatment of both the radius and ulna bones in the forearm"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 25492: Prophylactic treatment of the radius and ulna\",\"description\":\"CPT code 25492 covers prophylactic treatment (nailing, pinning, plating, or wiring with or without methylmethacrylate) of both the radius and ulna. This reference covers RVU values, Medicare reimbursement, ICD-10 crosswalks, modifiers, and global days.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-25492\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-08\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 25492 covers prophylactic fixation of both the radius and ulna, using nailing, pinning, plating, or wiring.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The code carries a 90-day global surgical period, so most post-op services are bundled and cannot be billed separately.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Modifier -50 is generally wrong on this code, because the descriptor already covers both forearm bones.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pair the code with forearm ICD-10 codes such as M84.533, not the upper-arm codes that sit beside them in the tabular list.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau tracks global periods and flags code-pair conflicts before claims go out.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\"><strong>CPT code 25492 is prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate of the radius AND ulna.<\/strong> The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a> publishes and maintains that descriptor as part of the CPT code set.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The key word is AND. This code applies when the surgeon treats both forearm bones in a single operative session, to prevent an impending or pathological fracture. It is not used when only one bone is treated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinical scenarios where CPT code 25492 is indicated include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Bone metastases:<\/strong> Secondary malignant neoplasm affecting both the radius and ulna, most commonly from breast, lung, prostate, or renal carcinoma<\/li>\n\n\n\n<li><strong>Fibrous dysplasia:<\/strong> A benign skeletal disorder causing bone weakening across one or both forearm bones<\/li>\n\n\n\n<li><strong>Paget&#8217;s disease of bone:<\/strong> Chronic disorder that disrupts bone remodeling, increasing fracture risk at the affected site<\/li>\n\n\n\n<li><strong>Osteoporosis with impending fracture:<\/strong> When bone mineral density loss creates a clinically significant risk of fracture at the forearm<\/li>\n\n\n\n<li><strong>Pathological fracture risk from radiation:<\/strong> Post-radiation osseous changes that weaken cortical integrity<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The surgeon may use any of the listed techniques: nailing, pinning, plating with screws, or wiring. Nailing is typically intramedullary. Methylmethacrylate, better known as bone cement, may or may not be used, and it does not change the code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation has to establish why prophylactic fixation is clinically appropriate before a fracture has occurred. That reasoning is what separates this code from the fracture repair family.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-25491-vs-25492-understanding-the-one-bone-vs-two-bone-distinction\" class=\"wp-block-heading\">25491 vs 25492: Understanding the one-bone vs two-bone distinction<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 25491 and CPT code 25492 are adjacent codes in the same descriptor family. The only structural difference is the number of bones treated. That difference still carries real billing and RVU consequences.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Feature<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 25491<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 25492<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Bones treated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radius OR ulna (one bone only)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radius AND ulna (both bones)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical clinical scenario<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Isolated metastatic lesion affecting one forearm bone<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral involvement or systemic disease affecting both bones<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (approx.)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower than 25492<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher, reflecting additional operative work<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Modifier -50 use<\/td>\n<td style=\"padding:12px 16px;color:#374151\">May apply if the same bone is treated on both sides<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not appropriate (both bones already included)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90 days<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90 days<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Coders sometimes bill CPT 25491 twice, once for each bone, when the operative note describes treatment of both the radius and ulna. Others append modifier -50 to 25491 instead. CPT code 25492 is the correct code in both scenarios, and billing 25491 twice creates audit exposure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Orthopedic practices with complex bone disease caseloads benefit from <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> that flags code-pair conflicts at the pre-submission stage. That is earlier than a payer&#8217;s edit engine would catch them.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-25492\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims management tools submit and track surgical claims, so a code-pair conflict on 25492 surfaces before the payer sees it.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-rvu-values-and-how-they-re-calculated\" class=\"wp-block-heading\">RVU values and how they&#8217;re calculated<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Centers for Medicare and Medicaid Services (CMS) assigns Relative Value Units (RVUs) to each CPT code to determine payment. RVUs for CPT code 25492 reflect the physician work involved in fixing two bones, not one. CMS updates these values annually, so always verify against the current <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> for the applicable year.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-facility setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same as facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reflects surgeon effort; unchanged by setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower (facility covers overhead)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher (practice bears overhead)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Differs significantly by setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reflects professional liability component<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">N\/A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used to calculate facility payment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">N\/A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used for office-setting reimbursement<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare payment is calculated as: <strong>[(Work RVU \u00d7 Work GPCI) + (PE RVU \u00d7 PE GPCI) + (MP RVU \u00d7 MP GPCI)] \u00d7 Conversion Factor.<\/strong> Each RVU component carries its own Geographic Practice Cost Index (GPCI) for the locality, so there is no single geographic multiplier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 2026 conversion factor is set by CMS through the annual Physician Fee Schedule final rule.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payers negotiate rates independently and typically reimburse at a percentage of Medicare, often 110-150%. That share varies widely by payer contract. Never apply a Medicare rate to a commercial claim without confirming the applicable fee schedule.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run your RVU calculations using the official CMS Physician Fee Schedule tool, not a third-party blog. CMS publishes the annual Physician Fee Schedule final rule in November, and the updates go live January 1. Download the database file and cross-reference by locality code for your geographic area.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-reimbursement-rates-by-setting\" class=\"wp-block-heading\">Medicare reimbursement rates by setting<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Setting matters significantly for CPT code 25492. Prophylactic fixation of both the radius and ulna is typically performed in a hospital or ambulatory surgical center (ASC). That places the physician in the facility reimbursement category, and the facility bills separately for its own costs.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Physician reimbursement basis<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Who bills for facility costs<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key consideration<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital inpatient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility RVUs (lower physician rate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital (DRG billing)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon bills professional component only<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital outpatient (HOPD)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility RVUs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital (OPPS APC rate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon rate same as inpatient<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">ASC<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility RVUs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASC (ASC payment rate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm 25492 is on the ASC-covered code list<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Office (rare)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility RVUs (higher rate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician practice<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unusual for this procedure; document appropriateness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">For practices managing orthopedic billing, <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy and orthopedic workflows<\/a> benefit from software that separates professional and technical components at the claim level. That separation reduces the risk of duplicate billing or a setting mismatch.<\/p>\n\n\n\n<h2 id=\"h-global-surgical-period-and-post-op-billing\" class=\"wp-block-heading\">Global surgical period and post-op billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 25492 carries a 90-day global surgical period, as listed in the CMS global days file. Medicare bundles most related post-operative services into the procedure payment for those 90 days. Other major orthopedic procedures behave the same way, including <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-22600\/\">CPT code 22600<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bundled services include routine post-operative visits, suture removal, wound checks, and uncomplicated follow-up assessments related to the fixation. Coders cannot separately bill evaluation and management (E\/M) services for these encounters. The exception is a separately identifiable new problem, which takes modifier -24.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Global period modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Documentation required<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-24<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated E\/M during post-op period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Note must clearly establish new, unrelated diagnosis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Return to OR for related complication<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Operative report establishing complication relationship<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated procedure during post-op period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Separate operative note for unrelated procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-58<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Staged or related procedure during post-op<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pre-operative plan for staged procedure<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Tracking 90-day global periods across a busy orthopedic or <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practice<\/a> is prone to error when managed manually. Software with built-in post-op tracking stops E\/M codes going out inside an active global period. That single error drives a large share of surgical denials and recoupments.<\/p>\n\n\n\n<h2 id=\"h-icd-10-codes-paired-with-cpt-25492\" class=\"wp-block-heading\">ICD-10 codes paired with CPT 25492<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity for CPT code 25492 is established through ICD-10-CM diagnosis codes. The diagnosis has to support prophylactic fixation of both bones. Payers may apply Local Coverage Determinations (LCDs) that restrict coverage to specific diagnoses, so check the applicable LCD before submission.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C79.51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary malignant neoplasm of bone<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common; metastatic disease from primary cancer<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M84.533<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pathological fracture in neoplastic disease, right radius<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when neoplasm has caused or is at high risk of fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M84.534<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pathological fracture in neoplastic disease, left radius<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Site-specific; use 7th character for encounter type<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M88.831<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Paget&#8217;s disease of bone, right forearm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chronic remodeling disorder increasing fracture risk<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M85.031<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fibrous dysplasia (monostotic), right forearm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Benign skeletal lesion; site-specific codes available<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M81.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Age-related osteoporosis without current pathological fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when advanced osteoporosis creates impending fracture risk<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Watch the middle digit in these families. In M84.5, M88.8, and M85.0, the middle digit of the final three sets the body part. A 2 means upper arm, and a 3 means forearm.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So M84.521 describes the humerus, and pairing it with 25492 is a medical necessity mismatch. Humerus work has its own procedure and diagnosis codes, including <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-24410\/\">CPT code 24410<\/a> and <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42302k\/\">ICD-10 code S42.302K<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For metastatic bone disease, code the primary malignancy alongside the bone involvement. ICD-10-CM sequencing guidelines require the primary site even when the encounter is for the metastatic site. A prostate primary managed with hormone therapy also generates its own drug claims under <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j1950\/\">HCPCS code J1950<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-25492\/comprehensive-patient-records.webp\" alt=\"Comprehensive patient records\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s patient records hold the imaging, the operative note, and the diagnosis together, so the ICD-10 choice on a 25492 claim is defensible.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Structured <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">clinical record workflows<\/a> keep that pairing documented in the patient record. Practices then have audit-ready evidence of how each medical necessity decision was reached.<\/p>\n\n\n\n<h2 id=\"h-applicable-modifiers-and-billing-considerations\" class=\"wp-block-heading\">Applicable modifiers and billing considerations<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection for CPT code 25492 carries meaningful risk if applied incorrectly. The two most commonly misapplied modifiers are -50 for a bilateral procedure and -59 for a distinct procedural service.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Definition<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use with 25492<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when both bones on the left side are treated (verify payer requirements)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when both bones on the right side are treated<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Generally not appropriate, because the code already covers radius and ulna. Payer policies vary.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">May apply when 25492 runs alongside another procedure under an NCCI edit. Use it only when the services are clinically distinct.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The -50 modifier requires particular care. CPT code 25492 already includes both the radius and ulna in its descriptor. Appending -50 to indicate a bilateral procedure invites a denial or an audit. Treating both forearms in one session is an unusual scenario, and it needs payer guidance rather than a reflex modifier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices with established <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA-compliant documentation practices<\/a> are better placed to defend modifier usage during payer audits. The rationale for each modifier is recorded in the patient record at the time of service.<\/p>\n\n\n\n<h2 id=\"h-ncci-edits-and-bundling-rules\" class=\"wp-block-heading\">NCCI edits and bundling rules<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The National Correct Coding Initiative (NCCI) sets code pairs that Medicare treats as inherently bundled. Those pairs cannot be billed together without a valid modifier override. NCCI edits are updated quarterly, so always check the current <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\" target=\"_blank\" rel=\"nofollow noopener\">NCCI edit files<\/a> before billing 25492 with another procedure on the same date.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Key bundling considerations for CPT code 25492:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fracture repair codes:<\/strong> Codes in the 25600-25699 range should not be billed with 25492 on the same date for the same bones. Prophylactic fixation and fracture repair describe different clinical scenarios, so billing both suggests a documentation problem.<\/li>\n\n\n\n<li><strong>Hardware removal codes:<\/strong> Codes such as 20670 are typically bundled within the global period of 25492 when performed for reasons related to the original procedure.<\/li>\n\n\n\n<li><strong>Methylmethacrylate:<\/strong> Bone cement is included in the 25492 descriptor and is not separately billable as a supply under most payer policies. Some payers allow a separate HCPCS supply code, so verify before billing it.<\/li>\n\n\n\n<li><strong>Casting and splinting:<\/strong> A cast or splint applied immediately after prophylactic fixation is generally bundled into the surgical global period. It cannot be billed separately on the same date.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">Automated billing workflows<\/a> reduce NCCI-related denials by cross-checking code pairs before the claim goes out. The check happens while the operative note is still in front of the coder.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-25492\/automated-communication-in-pabau.webp\" alt=\"Automated communication in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s automated messaging handles post-op follow-up during the 90-day global period, so recovery contact does not turn into a billable visit by accident.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Disputing an NCCI edit takes a valid modifier and an operative note showing the two services were clinically distinct and medically necessary. Document the decision-making in the operative report, not just on the claim.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Check the CMS NCCI edit files quarterly at cms.gov, rather than at the moment of claim submission. A quarterly review in your billing team&#8217;s calendar catches bundling changes before they cause denials. The NCCI Policy Manual for Medicare Services also explains the intent behind each edit category.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Orthopedic practices handling oncology referrals can connect <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">pre-operative digital forms<\/a> straight to the clinical record. The medical necessity rationale captured at intake then flows into the claim without being retyped.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-25492\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms in Pabau capture the pre-operative risk discussion that supports prophylactic fixation on the claim.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">How claims management software keeps CPT code 25492 clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most orthopedic practices, the pieces of this claim live in different places. The operative date sits in the surgical schedule and the post-op visits sit in the calendar. The global period sits in someone&#8217;s head, or in a spreadsheet. Day 63 after surgery looks like an ordinary follow-up until the denial arrives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the operative note, the global period, and the claim on one record. When a post-op appointment is booked inside the 90-day window, the E\/M code can be held back before it reaches the payer. Code-pair checks run at the same moment, so an NCCI conflict shows up while the coder can still fix it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The result is fewer denials on a code with a 90-day tail, and less time spent rebilling work that was documented correctly the first time. Every Pabau subscription includes the claims, records, and scheduling tools involved, so nothing here depends on an upgrade.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Simplify orthopedic billing workflows                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools help orthopedic and surgical practices track global periods, flag code-pair conflicts, and manage documentation for complex procedures like CPT code 25492.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard for orthopedic billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The two decisions that carry the most risk on this code are both made before the claim goes out. Match the code to the number of bones treated. Then pick the forearm diagnosis code, not the upper-arm one sitting beside it in the tabular list.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">After that, the 90-day global period does the rest of the damage on its own. Every post-op encounter for three months has to be checked against it, and no coder does that reliably from memory for long.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So build the checks into the system that already holds the operative note. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps surgical documentation, global periods, and claims in one place.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the coding rules for percutaneous fixation?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21452\/\">CPT code 21452<\/a> shows how the surgical approach changes the documentation a payer expects.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing an open fracture repair next?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21465\/\">CPT code 21465<\/a> walks through another 90-day global procedure and its post-op modifiers.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Unsure which seventh character to submit?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s33140a\/\">ICD-10 code S33.140A<\/a> breaks down encounter characters on a musculoskeletal claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Treating the humerus rather than the forearm?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-24410\/\">CPT code 24410<\/a> covers the upper-arm procedure family, with its own RVUs and ICD-10 pairings.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working out what bundles into a surgical claim?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11043\/\">CPT code 11043<\/a> explains debridement billing and the NCCI edits that come with it.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786952420298\"><h3 class=\"schema-faq-question\">What does CPT code 25492 describe?<\/h3> <p class=\"schema-faq-answer\">CPT code 25492 is prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate of both the radius and ulna. It is used when a surgeon stabilizes both forearm bones to prevent an impending or pathological fracture. The usual reasons are bone metastases, fibrous dysplasia, Paget&#8217;s disease, or severe osteoporosis.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952420299\"><h3 class=\"schema-faq-question\">What is the difference between CPT 25491 and CPT 25492?<\/h3> <p class=\"schema-faq-answer\">CPT 25491 covers prophylactic fixation of the radius OR ulna, meaning one bone. CPT code 25492 covers both the radius AND ulna in the same operative session. Using 25491 twice, or appending modifier -50 when both bones are treated, is incorrect. Code 25492 is the single correct code for the two-bone scenario.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952420300\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT 25492?<\/h3> <p class=\"schema-faq-answer\">Modifiers -LT and -RT apply, to specify the operative side. Modifier -50 for a bilateral procedure is generally not appropriate, because the descriptor already includes both bones. Modifier -59 may apply when 25492 runs alongside a procedure subject to an NCCI edit and the services are clinically distinct. That use needs supporting documentation and a payer policy check.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952420301\"><h3 class=\"schema-faq-question\">How many global days does CPT 25492 have?<\/h3> <p class=\"schema-faq-answer\">CPT code 25492 carries a 90-day global surgical period. Routine post-operative services within those 90 days are bundled into the payment and cannot be billed separately. Use modifier -24 for an unrelated E\/M service. Modifier -78 covers a return to the OR for a related complication, and -79 covers an unrelated procedure.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952420302\"><h3 class=\"schema-faq-question\">Can methylmethacrylate be billed separately with CPT 25492?<\/h3> <p class=\"schema-faq-answer\">Generally no. Methylmethacrylate, or bone cement, is included in the CPT code 25492 descriptor and is not separately payable under most Medicare and commercial payer policies. Some payers do allow a separate HCPCS supply code for the cement itself. Check that payer&#8217;s fee schedule and LCD before billing it as a supply item.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952420303\"><h3 class=\"schema-faq-question\">What ICD-10 codes are most commonly paired with CPT 25492?<\/h3> <p class=\"schema-faq-answer\">Four families cover most claims. C79.51 covers secondary malignant neoplasm of bone. M84.53x covers pathological fracture in neoplastic disease of the radius or ulna. M88.831 and M88.832 cover Paget&#8217;s disease of the forearm, while M85.03x covers fibrous dysplasia of the forearm. Always confirm the code satisfies the Local Coverage Determination for your Medicare Administrative Contractor jurisdiction.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>CPT code 25492 is prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate of the radius AND ulna. The American Medical Association (AMA) publishes and maintains that descriptor as part of the CPT code set. The key word is AND. This code applies when the surgeon treats both forearm bones in a single [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":181041,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"77","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[2405,2776,1602],"class_list":["post-181042","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-code-documentation","tag-cpt-coding","tag-cpt-modifiers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 25492: Radius and ulna fixation, RVUs and modifiers<\/title>\n<meta name=\"description\" content=\"CPT code 25492 covers prophylactic fixation of both forearm bones. It has a 90-day global period and pairs with codes like M84.533.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-25492\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 25492: Radius and ulna fixation, RVUs and modifiers\" \/>\n<meta property=\"og:description\" content=\"CPT code 25492 covers prophylactic fixation of both forearm bones. It has a 90-day global period and pairs with codes like M84.533.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-25492\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-17T08:08:04+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T08:35:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-25492.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"CPT code 25492: Prophylactic bone treatment of both the radius and ulna bones in the forearm\",\"datePublished\":\"2026-08-17T08:08:04+00:00\",\"dateModified\":\"2026-08-17T08:35:13+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/\"},\"wordCount\":2468,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-25492.webp\",\"keywords\":[\"Cpt code documentation\",\"CPT coding\",\"Cpt Modifiers\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/\",\"name\":\"CPT code 25492: Radius and ulna fixation, RVUs and modifiers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-25492\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-25492.webp\",\"datePublished\":\"2026-08-17T08:08:04+00:00\",\"dateModified\":\"2026-08-17T08:35:13+00:00\",\"description\":\"CPT code 25492 covers prophylactic fixation of both forearm bones. 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Check that payer's fee schedule and LCD before billing it as a supply item.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-25492\/#faq-question-1786952420303","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-25492\/#faq-question-1786952420303","name":"What ICD-10 codes are most commonly paired with CPT 25492?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Four families cover most claims. C79.51 covers secondary malignant neoplasm of bone. M84.53x covers pathological fracture in neoplastic disease of the radius or ulna. M88.831 and M88.832 cover Paget's disease of the forearm, while M85.03x covers fibrous dysplasia of the forearm. Always confirm the code satisfies the Local Coverage Determination for your Medicare Administrative Contractor jurisdiction.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 25492","seo_title":"CPT code 25492: Radius and ulna fixation, RVUs and modifiers","meta_description":"CPT code 25492 covers prophylactic fixation of both forearm bones. It has a 90-day global period and pairs with codes like M84.533.","content_score":"30","is_cornerstone":"","related_keyphrases":[]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/181042","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/82"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=181042"}],"version-history":[{"count":3,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/181042\/revisions"}],"predecessor-version":[{"id":181177,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/181042\/revisions\/181177"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/181041"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=181042"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=181042"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=181042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}