Summary & Overview
CPT 25391: Radius or Ulna Lengthening with Autologous Bone Graft
CPT code 25391 represents an orthopedic surgical procedure to lengthen the radius or ulna by performing an osteotomy and affixing an autologous bone graft. This reconstructive surgery is clinically significant for patients with congenital limb-length discrepancies, post-traumatic shortness, or selective reconstructive needs, and it is relevant to hospitals, ambulatory surgical centers, orthopedic surgeons, and payers managing high-cost surgical care nationally. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure and typical settings of care, plus coverage and billing considerations commonly encountered across major payers. The publication outlines common modifiers and coding practice patterns, highlights clinical context for use of the code, and summarizes what to expect in payer interactions and claim adjudication at a national level. Where specific comparative or payer-specific benchmark data are required, note that Data not available in the input. This piece is intended to orient billing managers, surgical coders, and policy analysts to the clinical purpose and administrative implications of CPT code 25391.
Billing Code Overview
CPT code 25391 describes a surgical procedure in which the provider performs an osteotomy of the radius or ulna and secures an autologous bone graft to lengthen the affected bone. This procedure is a form of limb-lengthening or reconstructive forearm surgery that uses the patient’s own bone graft material to increase the length of the radius or ulna.
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Service type: Surgical orthopedic procedure — forearm lengthening/reconstruction
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Typical site of service: Inpatient or outpatient hospital surgical suite, ambulatory surgical center, or specialty orthopedic surgical facility
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Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents with symptomatic congenital radial shortening causing wrist instability and functional impairment after prior conservative measures failed. Preoperative assessment includes history, physical exam documenting radial shortening and limited forearm rotation, radiographs and CT to plan osteotomy and determine bone graft length. In the operating room under general anesthesia with regional block, the orthopedic surgeon performs a diaphyseal or metaphyseal osteotomy of the radius (or ulna), harvests autologous corticocancellous bone graft (commonly from the iliac crest), inserts and secures the graft to lengthen the affected bone, and fixes the construct with internal fixation (plates/screws or external fixation). Intraoperative fluoroscopy confirms alignment and graft position. The surgical team documents the site (right or left), graft source, fixation method, estimated blood loss, and any complications. Typical postoperative workflow includes neurovascular checks, immobilization in a splint or cast, pain control, and outpatient follow-up with serial radiographs to assess graft incorporation and union. Rehabilitation with hand/forearm therapy commences per surgeon guidance when radiographic healing allows.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from technical facility charges (rare for operative procedures billed by surgeons). |