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Billing code 25426: Forearm bone repairMedicare rate & RVUs

Reports graft-assisted surgical repair of a radius and ulna nonunion or malunion when both forearm bones require reconstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,027.08 for 25426 nationally in a facility.

Medicare rate · 25426

Forearm bone repair

Swap in your local Medicare rate.

Work RVUs
16.04
Total RVUs
30.75
Global days
090

National rate · 2026

$1,027.08

Facility setting, before claim adjustments.

See every locality for 25426 → · 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 25426 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 25426 covers

An orthopedic or hand surgeon uses this service to reconstruct both forearm bones when a fracture has failed to unite or has healed in a position requiring correction. The operation addresses the radius and ulna together and includes grafting as part of the repair. These procedures are typically performed in an operating room for complex forearm fracture sequelae; the operative report should identify the condition and the work performed on each bone.

Select this code when the documented repair includes both the radius and ulna and meets the graft-related description for this code. Record the nonunion or malunion, the bones treated, the graft work, and any fixation or corrective reconstruction performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is paid at 150% for bilateral reporting. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery billing 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 25426 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

25426 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$930.47
Alaska*Unavailable$1,268.35
ArizonaUnavailable$998.98
ArkansasUnavailable$918.62
AtlantaUnavailable$1,057.62
AustinUnavailable$1,037.06
BakersfieldUnavailable$1,028.96
Baltimore/Surr. CntysUnavailable$1,090.20
BeaumontUnavailable$985.02
BrazoriaUnavailable$1,002.91

25426 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.

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25426 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 25426 rate is calculated

Each of 25426’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 · 25426

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 16.04Practice expense 11.30Malpractice 3.41

30.7500 adjusted RVUs×$33.4009 conversion factor=$1,027.08

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 25426

25426 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25426

Forearm bone repair

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 · 25426

Forearm bone repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

25426 without 50 · national facility

$1,027.08

Forearm bone repair

25426-50 · Bilateral: 150%

$1,540.62

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

25426 compared with similar codes

Compare codes

25426 vs 25415 vs 25420 vs 25425: national Medicare rates

Swap in your local Medicare rate.

  • 25426
    Forearm bone repair · 16.04 wRVU
    —
  • 25415
    Forearm bone repair · 13.46 wRVU
    —
  • 25420
    Forearm repair · 16.61 wRVU
    —
  • 25425
    Forearm bone repair · 13.38 wRVU
    —

How to choose

25415Forearm bone repair
This code describes repair of both forearm bones without graft. Use 25426 when the documented service includes the graft-related reconstruction.
25420Forearm repair
Both codes concern graft-assisted repair of the radius and ulna. Use the applicable code based on its full descriptor and the graft and repair details documented in the operative report.
25425Forearm bone repair
This is the graft-repair sibling for one bone, either the radius or ulna; 25426 is for repair involving both.

Codes related to 25426

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

Codes related to 25426
CodeHow it relatesNational office range
Same family
25415Forearm bone repairRepair of both radius and ulna without the graft-related service.No office rate
25420Forearm repairGraft-repair sibling for both bones; distinguish by the applicable full code descriptor and operative details.No office rate
25425Forearm bone repairGraft-repair sibling for one forearm bone rather than both.No office rate
25405Forearm bone repairGraft-repair sibling for the radius or ulna alone.No office rate

25426 billing questions

When should 25426 be selected instead of a code for one forearm bone?

Use 25426 when the graft-assisted repair addresses both the radius and ulna. A repair limited to only the radius or only the ulna belongs in the applicable one-bone code.

How does 25426 differ from 25415?

Both address repair of the radius and ulna, but 25415 is the corresponding repair code without graft. Choose based on the operative work and the applicable code descriptor.

What documentation supports reporting 25426?

The operative report should establish nonunion or malunion, identify both bones as treated, and describe the graft-assisted reconstruction and associated fixation.

How are other procedures in the same session paid?

CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the others. The code also has a 90-day global period that includes related postoperative care.

Can modifier 50 be used when both forearms are treated?

CMS lists this as a bilateral procedure, with modifier 50 paid at 150%. The operative documentation should support treatment of both sides.

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 25426PPRRVU2026_Oct_nonQPP.csv, line 2,454 (RVU26D)

Open CMS sourceHow we calculate rates

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