Billing code 25491: Bone stabilizationMedicare rate & RVUs in Guam
Reports operative stabilization of an ulna weakened and at risk for fracture, such as from destructive bone disease, before a fracture occurs.
CMS doesn’t publish an office rate for 25491 in Guam.
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 25491 covers
An orthopedic surgeon stabilizes the ulna before it breaks when disease or bone damage has made it vulnerable to fracture. The operation may use internal fixation such as a plate, pins, wires, or a nail; bone cement may also be used. A typical clinical setting is an operating room, with a destructive lesion, including one related to metastatic disease, creating concern for an impending fracture.
Choose this code when the operative goal is to prevent an ulna fracture, rather than to repair an existing fracture or a healing problem. The record should identify the ulna treated, the condition weakening the bone, the fracture risk, and the stabilization performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; 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.
25491 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $705.29 |
How the 25491 rate is calculated
Each of 25491’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 · 25491
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.90Practice expense 8.79Malpractice 2.11
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25491
25491 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25491
Bone stabilization
| 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) | 0 | Not permitted. |
| 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 · 25491
Bone stabilization
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
25491 without 50 · national facility
$694.74
Bone stabilization
25491-50 · Bilateral: 150%
$1,042.11
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).
25491 compared with similar codes
Compare codes
25491 vs 25490 vs 25492 vs 25400 vs 25405: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25490Prophylactic fixation
- Use 25490 when prophylactic stabilization is performed on the radius. This code is specific to the ulna.
- 25492Prophylactic fixation
- Use 25492 when both radius and ulna receive prophylactic treatment; 25491 identifies treatment of the ulna alone.
- 25400Forearm bone repair
- 25400 describes repair of an established radius or ulna healing problem. Choose 25491 when the operation is intended to prevent a fracture.
- 25405Forearm bone repair
- 25405 is for repair of a radius or ulna healing problem with grafting, not prophylactic stabilization of an at-risk ulna.
25491 billing questions
How does 25491 differ from 25490 and 25492?
25491 is for prophylactic stabilization of the ulna. Code 25490 is for the radius, while 25492 covers both the radius and ulna.
Can 25491 be used when the ulna is already fractured?
This code describes stabilization intended to prevent a fracture. When surgery repairs an established fracture or a nonunion, select the code that describes that repair instead.
What documentation supports reporting 25491?
Document the affected ulna, the bone-weakening condition, why fracture prevention is needed, and the fixation or other stabilization performed.
Does the 90-day global period include postoperative care?
Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon be reported with 25491?
Assistant-at-surgery services may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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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