Summary & Overview
CPT 25415: Osteotomy and Fixation for Radius and Ulna Nonunion/Malunion
CPT code 25415 covers surgical correction of nonunion or malunion deformities of the radius and ulna through osteotomy and fixation. This procedure is clinically significant for restoring forearm alignment, improving function, and reducing pain in patients with improperly healed fractures or congenital deformities. Nationally, such reconstructive procedures have implications for surgical utilization, post-operative rehabilitation needs, and durable medical equipment and prosthetics where applicable.
Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service (hospital operating room or ambulatory surgical center), and common billing considerations tied to this type of orthopedic reconstructive surgery. The publication provides benchmarks where available, summarizes relevant policy and coverage considerations, and situates the procedure within clinical pathways for nonunion and malunion management.
This briefing is intended for coders, billing managers, and policy analysts seeking clear guidance on the clinical intent of 25415, payer coverage landscape, and operational implications for surgical service lines. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 25415 describes a surgical procedure to correct nonunion or malunion deformities of the radius and ulna in the lower arm by performing osteotomy (cutting the bones) and achieving fixation by approximating the bone ends. The procedure addresses improperly healed or undeveloped bone segments to restore alignment and function.
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Service type: Surgical orthopedic reconstruction (osteotomy with internal or external fixation) of the radius and ulna
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Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on patient condition and surgeon decision
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents with persistent forearm pain, deformity, and limited pronation/supination following a prior radius and ulna fracture that failed to heal (nonunion) with malalignment. Conservative measures including immobilization and bone stimulation have failed. Imaging including plain radiographs and CT confirms atrophic nonunion and angular deformity of both bones in the distal third of the forearm. The orthopedic surgeon schedules an open corrective osteotomy of the radius and ulna with internal fixation using plates and screws and application of interfragmentary compression to restore alignment and length.
Preoperative workflow includes patient evaluation by orthopedic clinic, informed consent specific to nonunion/malunion correction, preoperative medical clearance, and scheduling in an ambulatory surgery center or hospital operating room depending on complexity and anesthesia needs. Intraoperative steps include exposure of the radius and ulna, resection of sclerotic bone ends, osteotomy or excision of nonunion tissue, reduction to correct angulation/rotation, fixation with appropriate hardware, and possible bone grafting. Postoperative workflow includes immediate postoperative neurovascular checks, dressing and splinting, discharge instructions with activity restrictions, and scheduled follow-up for wound check and radiographic monitoring of union.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |