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Billing code 25609: Distal radius fixationMedicare rate & RVUs

Report 25609 for open reduction and fixation of a distal radius fracture involving the joint surface with three or more fragments.

CMS RVU26DEffective Oct 1, 2026109 payment localities30.7K Medicare services in 2024

Medicare pays $968.29 for 25609 nationally in a facility.

Medicare rate · 25609

Distal radius fixation

Swap in your local Medicare rate.

Work RVUs
14.02
Total RVUs
28.99
Global days
090

National rate · 2026

$968.29

Facility setting, before claim adjustments.

See every locality for 25609 → · 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 25609 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 25609 covers

This service involves surgically exposing a distal radius fracture, restoring alignment of the joint surface, and stabilizing the fracture with fixation. It is typically performed by an orthopedic or hand surgeon for a complex, comminuted fracture that extends into the wrist joint. The procedure is commonly performed in a hospital operating room or ambulatory surgery center.

Choose this code when the fracture is intra-articular and has three or more fragments; the operative report should establish joint involvement, fragment count, open treatment, and fixation performed. Reduction and fixation are part of the service, not separate procedures. CMS assigns a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are 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 25609 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

25609 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$877.41
Alaska*Unavailable$1,187.72
ArizonaUnavailable$942.41
ArkansasUnavailable$866.19
AtlantaUnavailable$994.69
AustinUnavailable$982.43
BakersfieldUnavailable$980.46
Baltimore/Surr. CntysUnavailable$1,027.35
BeaumontUnavailable$925.04
BrazoriaUnavailable$948.16

25609 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
25609 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 25609 rate is calculated

Each of 25609’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 · 25609

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.02Practice expense 12.22Malpractice 2.75

28.9900 adjusted RVUs×$33.4009 conversion factor=$968.29

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

Payment rules and modifiers for 25609

25609 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25609

Distal radius fixation

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)0Not permitted.
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 · 25609

Distal radius fixation

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

25609 without 50 · national facility

$968.29

Distal radius fixation

25609-50 · Bilateral: 150%

$1,452.44

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

25609 compared with similar codes

Compare codes

25609 vs 25608 vs 25607 vs 25606 vs 25605: national Medicare rates

Swap in your local Medicare rate.

  • 25609
    Distal radius fixation · 14.02 wRVU
    —
  • 25608
    Distal radius repair · 10.79 wRVU
    —
  • 25607
    Distal radius repair · 9.32 wRVU
    —
  • 25606
    Distal radius fixation · 8.1 wRVU
    —
  • 25605
    Wrist fracture treatment · 6.09 wRVU
    $634.62

How to choose

25608Distal radius repair
Both are open fixation codes for intra-articular distal radius fractures. The fragment count distinguishes them: 25608 is for two fragments, while 25609 is for three or more.
25607Distal radius repair
25607 applies to an extra-articular distal radius fracture treated openly. Use 25609 for an intra-articular fracture with three or more fragments.
25606Distal radius fixation
25606 describes percutaneous skeletal fixation of a distal radius fracture. 25609 describes open treatment of an intra-articular fracture with three or more fragments.
25605Wrist fracture treatment
25605 is closed treatment with manipulation, rather than open reduction and fixation. Choose based on the treatment actually performed.

Codes related to 25609

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

Codes related to 25609
CodeHow it relatesNational office range
Same family
25608Distal radius repairOpen fixation of an intra-articular distal radius fracture involving two fragments.No office rate
Used instead
25607Distal radius repairOpen fixation applies when the distal radius fracture is extra-articular.No office rate
25606Distal radius fixationPercutaneous skeletal fixation is a different treatment approach for a distal radius fracture.No office rate
25605Wrist fracture treatmentClosed treatment with manipulation is used when the fracture is managed without open fixation.$558.08–$806.13
25600Fracture treatmentClosed treatment without manipulation is a different approach to a distal radius fracture.$337.54–$509.12

25609 billing questions

How is 25609 different from 25608?

Both describe open treatment of an intra-articular distal radius fracture with fixation. Use 25609 when there are three or more fragments; 25608 is for two fragments.

When should 25607 be reported instead?

25607 is for open treatment of an extra-articular distal radius fracture. The fracture treated with 25609 must extend into the wrist joint and involve three or more fragments.

Can reduction or fixation be billed separately?

No. The open reduction and fixation are included in 25609; document the fracture pattern and operative work supporting the code.

What documentation supports 25609?

The operative report should identify intra-articular extension, establish that three or more fragments are involved, and describe the open treatment and fixation.

How does the global period affect postoperative billing?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How does Medicare handle bilateral procedures or other procedures in the same session?

Bilateral reporting with modifier 50 is paid at 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%.

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 25609PPRRVU2026_Oct_nonQPP.csv, line 2,490 (RVU26D)

Open CMS sourceHow we calculate rates

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