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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Forearm and WristCPT cpt-25391-radius-ulna-lengthening-with-autologous-bone-graft
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    CPT 25391: Radius/Ulna Lengthening with Autologous Bone Graft

    Medicare pays $935 on average nationally for this procedure.

    CPT code 25391 describes a surgical procedure to lengthen the radius or ulna by performing an osteotomy (cutting the bone) and affixing an autologous bone graft to increase bone length; this is an orthopedic reconstructive procedure typically performed in an operating room or surgical suite and categorized as an open bone graft/osteotomy service for the forearm.

    For related coverage guidance, see recent payer policy updates: Implants for Joint Pain, Orthopedic Applications of Stem Cell Therapy, Bone Lengthening (Distraction Osteogenesis).

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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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    25391Osteotomy, radius or ulna, with bone graft, to increase length (autologous)Primary procedure: cuts and lengthens the radius or ulna using autologous bone graft to increase bone length and restore alignment/function.
    20936Autograft, any donor site, including reimplantation of bone obtained from same site (includes obtaining graft)May be reported when additional distinct bone graft harvesting beyond routine is performed from a separate donor site such as iliac crest and documentation supports separate reporting.
    25605Open treatment of distal radial fracture with internal fixationPerformed for cases where lengthening is combined with fracture fixation or correction of malunion at the distal radius.
    25490Osteotomy, radius or ulna, other than corrective osteotomy of the distal radius (without bone graft)Related procedure when an osteotomy is performed without grafting; used if grafting is not performed or separately reported.
    20680Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, or plate) requiring major surgeryMay be performed later to remove hardware placed for fixation after union is achieved.
    20930Allograft, morselized, or placement of osteopromotive materialUsed when bone graft substitute or allograft is used instead of autologous graft during lengthening.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    2080P0207X
    363L00000X
    2083P0901X
    163WP2201X
    224ZL0004X
    2086P0122X
    125J00000X

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Implants for Joint PainBlue Cross Blue Shield - Rhode Island2027-03-01
    Orthopedic Applications of Stem Cell TherapyBlue Cross Blue Shield - Rhode Island2027-01-01
    Bone Lengthening (Distraction Osteogenesis)Blue Cross Blue Shield - North Dakota2027-01-01
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Sacroiliac Joint Fusion for the Treatment of Adult Low-Back Pain Medical PolicyHealth-New-England2026-12-01
    Bone Grafts and Stabilization Devices for Spinal Defects - Medical PolicyHealth-New-England2026-12-01
    Implantable Shock Absorbers for Treatment of Knee Osteoarthritisblue cross blue shield - louisiana2026-12-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06

    Related Codes

    CPT-25260-FLEXOR-TENDON-REPAIR-FOREARM-WRIST-ACUTE

    CPT 25260: Flexor Tendon or Muscle Repair, Forearm or Wrist

    CPT-25263-DELAYED-FLEXOR-TENDON-REPAIR-FOREARM-WRIST

    CPT 25263: Delayed Repair of Flexor Tendon or Muscle, Forearm/Wrist

    CPT-25265-FLEXOR-TENDON-MUSCLE-REPAIR-WITH-AUTOLOGOUS-GRAFT-DELAY

    CPT 25265: Flexor Tendon/Muscle Repair with Autograft, Forearm or Wrist

    CPT-25270-EXTENSOR-TENDON-REPAIR-FOREARM-WRIST-ACUTE

    CPT 25270: Extensor Tendon Repair, Forearm or Wrist

    CPT-25272-DELAYED-EXTENSOR-TENDON-REPAIR-FOREARM-WRIST

    CPT 25272: Delayed Repair of Extensor Tendon or Muscle, Forearm/Wrist

    CPT-25274-DELAYED-EXTENSOR-TENDON-REPAIR-WITH-AUTOLOGOUS-GRAFT

    CPT 25274: Extensor Tendon/Muscle Repair with Autologous Graft

    CPT-25275-EXTENSOR-TENDON-REPAIR-WRIST-FOREARM-GRAFT

    CPT 25275: Extensor Tendon Repair of Forearm/Wrist with Graft

    CPT-25280-FOREARM-WRIST-TENDON-LENGTH-ADJUSTMENT-REPAIR

    CPT 25280: Tendon Shortening/Adjustment in Forearm or Wrist

    CPT-25290-FLEXOR-TENDON-RELEASE-FOREARM-WRIST-OPEN

    CPT 25290: Open Flexor Tendon Release, Forearm or Wrist

    CPT-25295-TENDON-ADHESION-RELEASE-FOREARM-WRIST

    CPT 25295: Tendon Adhesion Release, Forearm or Wrist

    Showing 1–10 of 53

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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