CPT 25574 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 25574: Open Treatment of Both-Bone Forearm Shaft Fracture, One Bone Fixed

CPT code 25574 represents an open surgical procedure for both-bone forearm shaft fractures in which one bone (radius or ulna) undergoes open reduction and possible internal fixation while the contralateral shaft fracture is treated without open reduction or hardware. This code is clinically significant because forearm shaft fractures frequently require precise alignment to restore forearm rotation and upper-extremity function, and coding specificity affects surgical reimbursement and quality measurement. Nationally, accurate use of this code supports consistent reporting of resource use for upper-extremity trauma and helps payers and health systems track surgical patterns.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coding intent, typical sites of service, and the clinical context for when this open procedure applies. Readers will find benchmarks for utilization and allowed services, summary guidance on documentation elements that justify this specific code selection, and discussion of common billing modifiers and coding pitfalls where applicable. Content is presented to inform billing professionals, surgical providers, and payers about the clinical definition, service setting, and reporting considerations for CPT code 25574 at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25574forearm fractureopen reduction internal fixationorthopedic surgeryupper extremitysurgical codingfracture management

Billing Code Overview

CPT code 25574 describes an open treatment of both-bone forearm shaft fracture in which the provider performs an incision and realignment (open reduction) of one forearm bone (radius or ulna) and may apply internal fixation hardware to that bone, while the other forearm shaft fracture is treated without open realignment or fixation. This service is an open surgical fracture treatment of the forearm shafts.

Service type: Open surgical reduction and internal fixation (for one bone) with treatment of the other bone without open reduction
Typical site of service: Hospital inpatient or outpatient surgical center, including operating room or procedure suite

Clinical & Coding Specifications

Clinical Context

A 42-year-old male presents to the emergency department after a fall from a bicycle with acute left forearm pain, deformity, and swelling. Radiographs demonstrate displaced fractures of both the radius and ulna shafts. In the operating room under general anesthesia, the surgeon performs an open reduction and internal fixation of the radius shaft via an incision to restore alignment and applies a plate-and-screw construct. The ulna shaft fracture is nondisplaced and remains stable after closed reduction, not requiring open fixation or hardware. Postoperative workflow includes immediate postoperative neurovascular checks, immobilization in a splint or cast, pain control, radiographic confirmation of hardware position, and scheduled orthopedic follow-up for wound check and progressive rehabilitation.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side physical modifier	Use when the procedure is performed on the left forearm.
`RT`	Right side physical modifier	Use when the procedure is performed on the right forearm.

CPT 25526: Open Repair of Radial Shaft Fracture with DRUJ Dislocation and TFCC Repair

CPT-25600-CLOSED-TREATMENT-DISPLACED-DISTAL-RADIUS-FRACTURE

CPT 25600: Closed Treatment of Displaced Distal Radius (Wrist) Fracture

CPT-25652-ULNAR-STYLOID-OPEN-TREATMENT-WRIST-FRACTURE

CPT 25652: Open Treatment of Ulnar Styloid Fracture, Wrist

CPT-25624-CLOSED-MANIPULATION-SCAPHOID-FRACTURE

CPT 25624: Closed Manipulation of Scaphoid Fracture

CPT-25685-OPEN-TREATMENT-WRIST-DISLOCATION-INTERNAL-FIXATION

CPT 25685: Open Treatment of Wrist Dislocation with Internal Fixation

CPT-25606-DISTAL-RADIUS-FRACTURE-PERCUTANEOUS-FIXATION

CPT 25606: Percutaneous Fixation of Distal Radius Fracture

25605-CLOSED-TREATMENT-OF-DISTAL-RADIAL-FRACTURE-EG-COLLES-OR

CPT 25605: Closed Treatment of Distal Radial Fracture

CPT-25680-CLOSED-REDUCTION-WRIST-DISLOCATION

CPT 25680: Closed Reduction of Wrist Dislocation

CPT-25560-CLOSED-TREATMENT-BOTH-BONE-FOREARM-SHAFT-FRACTURE

CPT 25560: Closed Treatment of Both-Bone Forearm Shaft Fracture

CPT-25500-CLOSED-TREATMENT-RADIAL-SHAFT-FRACTURE

CPT 25500: Closed Treatment of Radius Shaft Fracture

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Taxonomy Code	Specialty	Notes
207RC0000X	Orthopedic Surgery	Most common specialty performing forearm open reduction and internal fixation.
2080P0207X	General Surgery	May perform open fracture fixation in trauma settings or when orthopedics unavailable.
208500000X	Emergency Medicine	Performs initial assessment, reduction attempts, and coordinates operative care; not typical billing surgeon for definitive fixation.
363L00000X	Physical Therapy (PT)	Provides postoperative rehabilitation and range-of-motion restoration; included as an allied health taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S52.301A`	Unspecified fracture of shaft of ulna, initial encounter for closed fracture	Ulna shaft fractures commonly occur with radius fractures in both-bone forearm injuries; coding depends on laterality and encounter.
`S52.321A`	Unspecified fracture of shaft of radius, initial encounter for closed fracture	Radius shaft fractures often require open reduction and internal fixation when displaced; this code captures radius shaft involvement.
`S52.401A`	Fracture of both bone of forearm, unspecified, initial encounter for closed fracture	Used when both radius and ulna shafts are fractured and the initial encounter is closed; laterality-specific codes are preferred.
`S52.301B`	Unspecified fracture of shaft of ulna, initial encounter for open fracture	Used when the ulna shaft fracture is open; open fractures have different management implications.
`S52.321B`	Unspecified fracture of shaft of radius, initial encounter for open fracture	Used when the radius shaft fracture is open and requires debridement in addition to fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25607`	Closed treatment of radial shaft fracture; with manipulation, with or without external fixation	May be attempted prior to open fixation or used if closed reduction is successful without open internal fixation.
`25575`	Open treatment of both bone forearm fracture, with internal fixation of both radius and ulna shafts	Represents a more extensive procedure when both bones require open reduction and fixation; more comprehensive than the indexed code.
`20680`	Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, or rod)	May be performed in a later procedure if hardware removal is indicated after healing.
`23030`	Manipulation, under anesthesia, of forearm fracture	May be performed intraoperatively if closed manipulation is required prior to or in lieu of open reduction for the second bone.
`20690`	Application of external fixation device	May be used in the same patient if temporary stabilization with an external fixator is required due to soft tissue injury or contamination.

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