Summary & Overview
CPT 25535: Closed Treatment of Ulna Shaft Fracture, Manipulation
CPT code 25535 represents closed treatment (manipulation without incision) of a fracture of the shaft of the ulna, a common forearm injury. This code captures non-operative fracture management where alignment is achieved by manipulation rather than open surgical exposure. Nationally, accurate coding for closed reductions affects clinical documentation, billing consistency, and claims adjudication for acute musculoskeletal injuries across emergency, urgent care, and outpatient orthopedic settings.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common billing modifiers used with closed fracture care, and benchmarks for service settings where 25535 is typically billed. The publication also provides clinical context about the procedure type, typical sites of service, and the implications for coding accuracy and claims processing.
The content is designed to inform coding professionals, billing managers, and clinicians about where 25535 fits in procedural coding, common operational considerations for non-operative ulna shaft fracture management, and the kinds of policy and reimbursement issues to monitor at a national level.
Billing Code Overview
CPT code 25535 describes a closed treatment of a fracture of the shaft of the ulna. The provider manipulates the fracture into proper alignment without making a surgical incision.
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Service type: Closed fracture management (manipulation, non-operative)
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Typical site of service: Emergency department, urgent care, or outpatient clinic where closed fracture reductions are performed
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents to the emergency department or orthopedic clinic after a fall onto an outstretched hand or a direct blow to the forearm. The patient reports localized pain, swelling, and deformity over the ulna shaft, with point tenderness and limited forearm rotation. Initial evaluation includes neurovascular exam and plain radiographs (AP and lateral) confirming a displaced fracture of the ulnar shaft without skin break. The provider performs a closed reduction under local or regional anesthesia or conscious sedation, manipulating the fragments into acceptable alignment without an incision. Post-reduction radiographs confirm alignment. The limb is immobilized in a long-arm cast or splint; neurovascular status is rechecked and follow-up arranged with orthopedics for repeat imaging and potential operative fixation if stability is inadequate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | Use when a separate evaluation is performed and documented on the same day as the closed reduction (Note: 25 was not in provided list; therefore Data not available in the input.) |
50 |