CPT Code 25565: Closed treatment of radial and ulnar shaft fractures

Key Takeaways

CPT code 25565 describes closed (non-surgical) treatment of both the radial and ulnar shaft fractures simultaneously, with manipulation to realign the bones.

The short and medium descriptions for CPT 25565 were updated effective January 1, 2025 – verify your billing templates reflect the current wording.

A 90-day global surgery period applies; post-operative visits within that window are bundled and cannot be billed separately.

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CPT code 25565 describes closed treatment of radial and ulnar shaft fractures with manipulation. “Closed treatment” means no surgical incision is made; the physician manually realigns the fracture fragments through external force. “With manipulation” distinguishes it from CPT 25560, which covers the same injury treated without realignment. The code sits within the AMA’s CPT code set under Surgical Procedures on the Forearm and Wrist, subsection Fracture and/or Dislocation Procedures. For practices that frequently bill this code alongside other CPT coding guides, keeping your fee schedule current is critical.

Effective January 1, 2025, FindACode confirmed that both the short and medium descriptions for CPT 25565 were revised. The long-form descriptor remains: Closed treatment of radial and ulnar shaft fractures; with manipulation. Billing staff should verify their practice management superbills and EHR code libraries reflect the updated short description to avoid claim rejections stemming from outdated descriptor mismatches.

What CPT 25565 covers clinically

This code applies when both the radius and the ulna shaft fractures are treated in the same session through closed (non-surgical) manipulation. Both bones must be involved; single-bone fractures use separate codes (25505 for the radius, 25545 for the ulna).

The procedure typically involves conscious sedation or regional anesthesia, followed by manual traction and rotation to restore bone alignment. The arm is then immobilized in a cast or splint. Post-reduction imaging confirms alignment before the patient leaves.

When CPT 25565 applies vs. adjacent codes

Selecting the correct code hinges on two variables: how many bones are fractured, and whether manipulation was performed. The table below maps the key forearm fracture codes.

The most common confusion is between CPT 25560 and CPT 25565. If the physician documents only immobilization without fracture reduction, 25560 is correct. If the operative note describes manual reduction, traction, or rotational correction before casting, 25565applies. Missing that distinction is a frequent audit finding.

Modifiers for CPT code 25565

Modifier selection for CPT 25565 depends on payer requirements and clinical circumstances. Always check individual payer policies before appending modifiers not explicitly required.

• Modifier RT / LT: Many payers, including commercial insurers and some Medicare contractors, require laterality modifiers to indicate the right (RT) or left (LT) forearm. Per AAPC Codify guidance, appending RT or LT reduces the risk of rejection when a payer’s editing system flags missing laterality. Not all payers require them, so confirm before adding.
• Modifier 50 (Bilateral Procedure): Simultaneous bilateral forearm fracture treatment is rare but possible. When both arms are treated in the same session, modifier 50 may apply. Medicare pays 150% of the single-procedure fee for bilateral procedures.
• Modifier 59 (Distinct Procedural Service): Use modifier 59 when CPT 25565 is billed alongside another procedure that would otherwise be bundled per NCCI edits, and the services are genuinely separate and distinct. Avoid using 59 as a blanket unbundling tool; each use requires documentation support.
• Modifier 54 / 55: When fracture care is split between providers (e.g., the treating physician performs the initial manipulation and a different physician handles post-op care), modifier 54 (surgical care only) and modifier 55 (postoperative management only) divide the global fee appropriately.

A 2019 AAPC Orthopedic Coding Alert newsletter confirmed that modifier RT appended to CPT 25565 is the standard laterality approach for many payers, with CPT 73090 (forearm X-ray, two views) separately reportable when radiology is performed and documented. Verify current NCCI edits before billing 73090 alongside 25565, as bundling rules may vary.

ICD-10 codes paired with CPT code 25565

Medical necessity requires a matching ICD-10-CM diagnosis code. The diagnosis must document fracture type, laterality, and episode of care. Using a non-specific code when a more specific one is available risks medical necessity denials.

Key ICD-10-CM codes commonly linked to CPT 25565 include fractures of the radial and ulnar shaft. Laterality and episode of care (initial encounter = A, subsequent = D, sequela = S) must match the visit type. For ICD-10 coding for medical procedures more broadly, the same specificity rules apply across all body systems.

Both fracture codes (radius and ulna) should be listed on the claim when CPT 25565 is billed, since the CPT code describes treatment of both bones. Using only one diagnosis code when two bones are fractured can trigger a medical necessity mismatch. For ICD-10 diagnostic code selection guidance in other specialties, the same pairing logic applies: one CPT code can justify multiple ICD-10 codes when the clinical picture supports it.

CPT code 25565 reimbursement and fee schedule

CPT 25565 carries a 90-day global surgery period. This means pre-operative visits one day before surgery and all routine post-operative follow-up visits within 90 days are bundled into the single procedure fee. Billing a separate E/M visit for routine fracture check-ups within the global period will trigger a denial or overpayment recovery.

Medicare reimbursement rates vary by locality and are updated annually. For current 2025 payment amounts, use the CMS Physician Fee Schedule lookup tool. For RVU-based reimbursement calculations, FastRVU’s 2026 RVU lookup provides work, practice expense, and malpractice RVU values by locality. Commercial payer rates typically exceed Medicare rates, but vary by contract.

Global period billing rules

• Day 0 (surgery day): The procedure fee covers the operation and any E/M on the same day if a separately identifiable service is documented with modifier 25.
• Days 1-90: Routine follow-up visits are bundled. Do not bill separately for cast checks, wound checks, or standard progress visits.
• Unplanned return to OR: Use modifier 78 if the patient returns to the operating room for a related procedure during the global period.
• Complications requiring new decision-making: An E/M visit for a new, unrelated condition can be billed with modifier 24 (unrelated E/M service during a postoperative period).

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Prior authorization requirements for CPT 25565

Prior authorization requirements for CPT 25565 are payer-specific and not universal. A November 2023 UPMC Health Plan provider announcement confirmed that CPT 25565 is among the musculoskeletal codes requiring prior authorization from that plan. This requirement does not extend to all payers.

Best practice is to check authorization requirements for each payer before scheduling the procedure. Most payer portals allow real-time authorization lookups by CPT code. Sports medicine practice management platforms and physical therapy EMR systems that integrate with payer portals can flag authorization requirements automatically during scheduling, reducing the chance of a claim reaching adjudication without the required auth number.

Documentation checklist for prior authorization

• Mechanism of injury and date of fracture
• Clinical findings supporting both radial and ulnar fractures (physical exam, imaging results)
• Imaging report confirming fracture location (shaft, not distal radius or wrist)
• Reason closed manipulation is the appropriate treatment (vs. surgical fixation)
• Physician credentials and specialty
• Facility or office setting where procedure will be performed

Documentation requirements to support CPT code 25565

Payers audit fracture care codes at higher rates than many other surgical procedures. The operative note or procedure note for CPT 25565 must support every element of the code descriptor. HIPAA-compliant documentation practices require that records be complete, accurate, and accessible for up to six years from creation.

A compliant note for CPT 25565 should include the following elements. Missing any one of these creates an audit vulnerability. Standardized clinical documentation templates help ensure nothing is omitted during a busy clinical day.

• Patient presentation: Mechanism of injury, symptom onset, initial physical exam findings (swelling, deformity, neurovascular status).
• Imaging interpretation: Reference to X-ray or CT findings confirming fracture of both the radial and ulnar shafts. Note the location (shaft, not metaphysis or distal radius).
• Manipulation technique: Explicit documentation that manual reduction was performed. Describe the technique: traction, counter-traction, rotational correction. Without this, auditors may downcode to 25560.
• Post-reduction imaging: Confirmation that alignment was assessed after manipulation.
• Immobilization: Type (cast, splint, brace), material, and position of immobilization.
• Neurovascular check: Post-procedure assessment of circulation, sensation, and motor function in the hand and fingers.
• Follow-up plan: Instructions given to the patient, scheduled follow-up timing, return precautions.

NCCI edits and bundling considerations

National Correct Coding Initiative (NCCI) edits define which codes cannot be billed together without additional justification. For CPT 25565, key bundling scenarios include:

• Anesthesia codes: If the operating physician provides the anesthesia, anesthesia codes are bundled into the surgical fee and cannot be billed separately.
• E/M on the day of surgery: A same-day E/M visit is bundled unless modifier 25 is appended and the visit represents a separately identifiable evaluation and management service beyond the procedure decision.
• Radiologic supervision and interpretation: When the operating physician reads the X-ray, CPT 73090 may be separately reportable with the appropriate radiology code. If a radiologist interprets the film, the radiologist bills 73090 and the surgeon does not.
• Single-bone codes: Do not bill CPT 25505 (radial shaft with manipulation) or CPT 25535 (ulnar shaft with manipulation) alongside 25565. CPT 25565 already covers treatment of both bones.

For procedure-specific CPT billing across other specialties, the same NCCI edit logic applies. Practices using claims management software with built-in NCCI edit checking can catch bundling errors before submission, reducing denial rates significantly.

Conclusion

Miscoding a both-bone forearm fracture as 25560 instead of 25565 is a documentation problem before it is a billing problem. If the note does not say manipulation, the coder cannot justify the higher-complexity code, and the claim either underpays or gets denied on audit. The fix is systematic: standardized operative note templates that prompt documentation of reduction technique, post-reduction imaging, and neurovascular assessment.

Pabau’s practice management software helps orthopedic and sports medicine practices build structured clinical note workflows, attach correct CPT codes with modifier flags, and track claims through adjudication. Book a demo to see how Pabau handles fracture care documentation and billing in a single platform.

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