Summary & Overview
CPT 25455: Distal Radius and Ulna Growth Modulation with Implant
CPT code 25455 represents a surgical growth modulation procedure in the distal radius and ulna where screws or specialized staples are implanted in the epiphyseal region to temporarily pause bone growth. This code is relevant nationally due to its role in pediatric orthopedic management of growth deformities and limb length or angular discrepancies. Use of this code tracks procedural volumes, payer coverage patterns, and clinical practice variability for an important corrective intervention in skeletally immature patients.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of coverage and billing considerations across major commercial payers and Medicare, while noting where payer-specific policy details are not available.
Readers will learn the clinical context for the procedure, typical sites of service, and how the code is classified within procedural coding. The report summarizes common billing modifiers and outlines what information is and is not available in the input. Benchmarks, payer policy updates, and coding nuances are discussed to help administrators and clinicians understand coding implications and where to seek payer-specific guidance.
Billing Code Overview
CPT code 25455 describes a surgical procedure in which the provider implants screws or specialized staples into the epiphyseal (growth plate) region of the distal radius and ulna near the wrist to temporarily halt longitudinal growth of those bones. This intervention is a targeted growth modulation technique used to address radial and ulnar growth discrepancies or angular deformities in skeletally immature patients.
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Service type: Surgical growth modulation of the distal forearm (epiphyseal tethering/temporary hemiepiphysiodesis)
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Typical site of service: Ambulatory surgical center or hospital operating room
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a skeletally immature child or adolescent presenting with wrist deformity, painful radial or ulnar growth disturbance, or progressive angular deformity of the distal radius and/or ulna. Evaluation includes history, physical exam, and imaging (radiographs of the wrist with comparison views). When progressive asymmetric growth of the distal radial or ulnar physis is identified and conservative management is insufficient, the orthopedic surgeon performs temporary hemiepiphysiodesis of the distal radius and/or ulna by implanting screws or specialized staples across the physis to arrest growth on one side and correct angular deformity over time. The clinical workflow includes preoperative planning (indication, imaging, informed consent), operating room procedure under general anesthesia with fluoroscopic guidance to place 25455 devices across the distal radial/ulnar physis, immediate postoperative imaging to confirm hardware position, routine postoperative immobilization and follow-up visits for radiographic monitoring, and eventual hardware removal when desired correction is achieved.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when procedure was performed on the left distal radius/ulna |