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Billing code 25391: Bone lengtheningMedicare rate & RVUs

Reports an operation to lengthen a shortened radius or ulna, typically to address a forearm bone-length discrepancy or deformity.

CMS RVU26DEffective Oct 1, 2026109 payment localities33 Medicare services in 2024

Medicare pays $919.19 for 25391 nationally in a facility.

Medicare rate · 25391

Bone lengthening

Work RVUs
13.92
Total RVUs
27.52
Global days
090

National rate · 2026

$919.19

Facility setting, before claim adjustments.

See every locality for 25391 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 25391 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 25391 covers

The surgeon makes a corrective cut in one forearm bone and lengthens it to address shortening or a resulting alignment problem. Orthopedic and hand surgeons may perform this operation for a growth-related difference, congenital shortening, or a post-traumatic deformity. It is generally performed in an operating room, often in a hospital or ambulatory surgery setting; the operative report should identify the bone treated and the lengthening performed.

Report 25391 when the procedure lengthens either the radius or the ulna, rather than both bones. Documentation should support the indication, the specific bone, and the operative work; lengthening both bones is represented by a different code. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 bilateral payment is 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 25391 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

25391 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$831.76
Alaska*Unavailable$1,130.20
ArizonaUnavailable$893.90
ArkansasUnavailable$821.02
AtlantaUnavailable$946.21
AustinUnavailable$929.41
BakersfieldUnavailable$923.32
Baltimore/Surr. CntysUnavailable$976.06
BeaumontUnavailable$880.19
BrazoriaUnavailable$897.89

25391 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
25391 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 25391 rate is calculated

Each of 25391’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 25391

RVUs × geographic indexes × conversion factor

Work13.92

13.92 RVUs× 1.000 GPCI

Practice expense10.63

10.63 RVUs× 1.000 GPCI

Malpractice2.97

2.97 RVUs× 1.000 GPCI

Adjusted RVUs

27.5200

Conversion factor

$33.4009

Medicare rate

$919.19

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 25391

25391 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25391

Bone lengthening

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 25391

Bone lengthening

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

25391 without 50 · national facility

$919.19

Bone lengthening

25391-50 · Bilateral: 150%

$1,378.79

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

25391 compared with similar codes

Compare codes · National

4 codes, side by side

  • 25391

    Bone lengthening13.92 wRVU

    Not priced

  • 25390

    Bone shortening10.43 wRVU

    Not priced

  • 25392

    Forearm osteotomy14.22 wRVU

    Not priced

  • 25393

    Forearm lengthening16.15 wRVU

    Not priced

How to choose

25390Bone shortening
25390 describes shortening one forearm bone; 25391 describes lengthening one. Select based on the direction of the change documented in the operation.
25392Forearm osteotomy
25392 is for shortening both the radius and ulna. It is not the one-bone lengthening service represented by 25391.
25393Forearm lengthening
25393 describes lengthening both forearm bones, while 25391 describes lengthening either the radius or the ulna.

Codes related to 25391

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 25391
CodeHow it relatesNational office range
Same family
25390Bone shorteningShortens one forearm bone rather than lengthening it.No office rate
25392Forearm osteotomyShortens both forearm bones.No office rate
25393Forearm lengtheningLengthens both forearm bones rather than one.No office rate

25391 billing questions

When should 25391 be chosen over 25393?

Use 25391 when the surgeon lengthens one forearm bone, either the radius or ulna. Use 25393 when both bones are lengthened.

How does 25391 differ from 25390?

Both describe work on one forearm bone, but 25391 lengthens it and 25390 shortens it. The operative report should make the direction of the bone-length change clear.

Are related postoperative visits separately reported?

Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit. The global period begins with the operation.

How is bilateral performance handled?

The CMS bilateral rule specifies modifier 50 and payment at 150%. Documentation should identify the procedures performed on each side.

What documentation supports reporting 25391?

The operative report should identify whether the radius or ulna was lengthened and describe the corrective work. If both bones were lengthened, consider the code for lengthening both rather than 25391.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 25391PPRRVU2026_Oct_nonQPP.csv, line 2,445 (RVU26D)

Open CMS sourceHow we calculate rates

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