Summary & Overview
CPT 25400: Osteotomy and Fixation for Radius or Ulna Nonunion/Malunion
CPT code 25400 represents surgical correction of nonunion or malunion deformities of the radius or ulna through osteotomy and fixation. This orthopedic procedure restores alignment and stability of the lower arm to promote bone healing and functional recovery. It is a clinically significant intervention for patients with failed fracture healing or congenital/developmental deformities that compromise arm function and may involve complex reconstruction techniques.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of the clinical context for CPT code 25400, typical sites of care, and the kinds of benchmarks and policy considerations that commonly accompany surgical musculoskeletal codes. The publication covers expected service settings (hospital operating rooms and ambulatory surgery centers), common clinical indications, and the payer landscape relevant to utilization and coverage reviews.
The analysis provides practical reference material: coding description and clinical scope, payer inclusion for benchmarking, and areas where policy updates or coverage criteria often affect approval and reimbursement. Data not available in the input will be noted where applicable, and readers should expect sections on utilization benchmarks, modifier use, and related coding where source data permits.
Billing Code Overview
CPT code 25400 describes an operative procedure to correct a nonunion or malunion deformity of the radius or ulna in the lower arm. The procedure involves performing an osteotomy (cutting through the poorly developed or improperly healed bone) and achieving fixation by bringing the bone ends together to restore alignment and promote healing.
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Service type: Surgical orthopedic reconstruction of the forearm (osteotomy with internal fixation)
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Typical site of service: Hospital operating room or ambulatory surgery center, depending on clinical complexity and patient factors
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Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to orthopedic surgery clinic with persistent forearm pain, limited pronation-supination, and functional impairment six months after a motor vehicle collision that resulted in a radius fracture treated nonoperatively. Imaging (radiographs and CT) demonstrates a symptomatic nonunion of the distal radius with malalignment and shortening. The surgeon plans an open osteotomy with debridement of the nonunion site and internal fixation with plate and screws to restore length and alignment and promote union. Preoperative workflow includes history and physical, informed consent, preop imaging, anesthesia evaluation, and perioperative antibiotics. The procedure is typically performed in an ambulatory surgery center or hospital operating room under general or regional anesthesia. Postoperative workflow includes immobilization in a splint or cast, pain management, wound care instructions, and scheduled radiographic follow-up with physical therapy for range-of-motion and strengthening as healing permits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left radius or ulna. |
RT | Right side |