Summary & Overview
CPT 25491: Ulnar Defect Fixation with Internal Implants
CPT code 25491 denotes surgical fixation of an ulnar bone defect using internal implants such as nails, plates, or screws, with optional use of methylmethacrylate bone cement. This procedure is a core orthopedic service for restoring forearm stability and function after trauma, tumor resection, or nonunion. Nationally, it matters because it represents a resource-intensive operative intervention with implications for hospital surgical throughput, device utilization, and post-operative care pathways.
Key payers included in the coverage and comparative context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise clinical context about when the procedure is used, typical sites of service, and how the code fits into surgical orthopedic care. The publication also outlines expected benchmarking topics and policy-relevant items readers can expect: utilization benchmarks, payer coverage patterns, billing and coding considerations, and intersections with device and implant policy. Data not available in the input for specific payer rates, associated taxonomies, and ICD-10 diagnoses are noted as unavailable. The summary prepares clinicians, coding professionals, and policy analysts to understand the code's clinical role and the types of analyses commonly performed for operative fixation procedures of the ulna.
Billing Code Overview
CPT code 25491 describes a surgical procedure to treat a defect in the ulna (one of the forearm bones) using internal fixation implants such as nails, plates, or screws. The procedure may include the use of methylmethacrylate bone cement but can be performed with or without it. This service is an orthopedic operative procedure focused on restoring structural integrity and function of the ulna.
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Service type: Orthopedic surgical fixation of ulna defect
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old male construction worker presents with persistent forearm pain, deformity, and functional limitation 10 weeks after a comminuted midshaft ulnar fracture sustained in a fall. Radiographs and CT demonstrate a nonunion with segmental bone loss and instability of the ulna. The orthopedic surgeon plans operative management with open reduction and internal fixation using plates and screws; methylmethacrylate bone cement may be used to fill a cavitary defect if needed. The patient is admitted for the procedure under general anesthesia, perioperative antibiotic prophylaxis is given, and intraoperative fluoroscopy guides hardware placement. Postoperatively the patient receives immobilization, pain management, and scheduled outpatient physical therapy for range-of-motion and strengthening. Typical documentation includes preoperative diagnosis, procedure note specifying fixation implants (plate, screws, or intramedullary nail), use or nonuse of bone cement, estimated blood loss, anesthesia record, and postoperative care instructions for wound and rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and effort substantially exceed typical for 25491 and documentation supports increased complexity. |