Summary & Overview
CPT 25355: Radius Osteotomy, Upper or Middle Third
CPT code 25355 represents a surgical radius osteotomy targeting the middle or upper one-third of the forearm to correct angular deformities and related structural abnormalities. This procedure is clinically important because it addresses functional impairment, pain, and deformity that can affect the elbow, forearm, and wrist. Nationally, surgical correction of forearm deformities involves coordination between orthopedic surgeons, hospitals, and payers to ensure appropriate authorization and site selection.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context of the procedure, expected sites of service, and the types of benchmarking and policy considerations typically associated with operative orthopedic procedures. The publication summarizes common payer coverage patterns, utilization benchmarks where available, and relevant policy updates that influence preauthorization, place-of-service determinations, and coding validation for surgical osteotomies.
This summary provides clinicians, billing staff, and policy analysts with the clinical description, service setting, and the scope of payer coverage discussion they can expect in the full publication. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 25355 describes a surgical procedure in which bone is excised from the middle or upper one-third of the radius to correct forearm deformities, such as angular deformity. This procedure is an osteotomy of the radius (middle or upper third) aimed at restoring alignment, improving function, and addressing deforming conditions of the forearm.
-
Service type: Surgical orthopedic procedure (radius osteotomy)
-
Typical site of service: Hospital operating room or ambulatory surgical center, performed by orthopedic surgeons specializing in upper extremity reconstruction.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 12–16-year-old adolescent or an adult presenting with an angular deformity of the forearm (commonly congenital malunion, growth-plate arrest, or posttraumatic deformity) causing functional limitation, pain, or cosmetic concern. The patient reports progressive bowing or rotation of the forearm, decreased range of motion at the elbow or wrist, and difficulty with activities requiring forearm rotation or weight-bearing. Imaging (plain radiographs ± CT) demonstrates an angular deformity in the middle or upper one-third of the radius amenable to corrective osteotomy.
Preoperative workflow includes clinical assessment by an orthopedic surgeon (hand/upper extremity or pediatric orthopedics), templating correction on radiographs, preoperative discussion of risks and benefits, and scheduling for operative correction. In the operating room under regional or general anesthesia, the surgeon performs a radial osteotomy (excision of bone in the middle or upper third of the radius) with deformity correction, internal fixation (plates, screws, intramedullary devices) as indicated, and intraoperative fluoroscopy to confirm alignment. Postoperative workflow includes pain control, immobilization (splint or cast), physical therapy referrals, wound checks, and radiographic follow-up to confirm healing and alignment restoration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required is substantially greater than typical for (document specific reasons: complex exposure, extensive deformity, additional bone resection). |