Billing code 25426: Forearm bone repairMedicare rate & RVUs in Florida
Reports graft-assisted surgical repair of a radius and ulna nonunion or malunion when both forearm bones require reconstruction.
CMS doesn’t publish an office rate for 25426 in Florida.
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 9 sections
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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $1,124.01 |
| Miami | Unavailable | $1,216.70 |
| Rest Of Florida | Unavailable | $1,067.76 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
25426 compared with similar codes
Compare codes
25426 vs 25415 vs 25420 vs 25425: national Medicare rates
Swap in your local Medicare rate.
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.
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
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