Billing code 25490: Prophylactic fixationMedicare rate & RVUs in Illinois
Reports operative stabilization of the radius to prevent an impending pathological fracture, using fixation such as a nail, plate, pin, or wire.
CMS doesn’t publish an office rate for 25490 in Illinois.
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 25490 covers
An orthopedic surgeon reports this service when the radius is at risk of a pathological fracture and is stabilized before a fracture occurs. This may arise with a bone lesion, including metastatic disease, that has weakened the bone. The surgeon may use a nail, plate, pin, or wire, with or without bone cement. These procedures are typically performed in an operative facility rather than an office.
Select the code when the operative purpose is prevention of an impending fracture in the radius, not repair of an existing fracture or nonunion. The operative report should identify the radius, the lesion or bone weakness creating fracture risk, and the stabilization performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery 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.
Where 25490 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $769.77 |
| East St. Louis | Unavailable | $723.58 |
| Rest Of Illinois | Unavailable | $691.09 |
| Suburban Chicago | Unavailable | $740.96 |
How the 25490 rate is calculated
Each of 25490’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 · 25490
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.49Practice expense 8.81Malpractice 2.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25490
25490 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25490
Prophylactic fixation
| 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 · 25490
Prophylactic 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
25490 without 50 · national facility
$678.71
Prophylactic fixation
25490-50 · Bilateral: 150%
$1,018.07
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).
25490 compared with similar codes
Compare codes
25490 vs 25491 vs 25492 vs 25400 vs 25405: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25491Bone stabilization
- 25491 covers prophylactic stabilization of the ulna; 25490 is for the radius.
- 25492Prophylactic fixation
- Use 25492 when prophylactic treatment includes both forearm bones; 25490 is limited to the radius.
- 25400Forearm bone repair
- 25400 is a repair code for an established radius or ulna problem. 25490 applies when fixation is preventive and performed before a pathological fracture.
- 25405Forearm bone repair
- 25405 describes repair with grafting of an established radius or ulna problem; it is not the prophylactic stabilization code.
25490 billing questions
When is 25490 used instead of a radius repair code?
Use 25490 when fixation is performed to prevent an impending pathological fracture. Codes such as 25400 or 25405 describe repair of an established radius or ulna problem, rather than prophylactic stabilization.
How does 25490 differ from 25492?
25490 is for prophylactic stabilization of the radius alone. 25492 covers prophylactic treatment of both the radius and ulna.
What documentation supports prophylactic treatment?
Document the at-risk bone, the lesion or other bone weakness, why fracture is impending, and the fixation performed. The record should make clear that stabilization was preventive rather than treatment of an existing fracture.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery for this code. Co-surgeons and team surgery are not permitted under the listed CMS rules.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Bilateral reporting with modifier 50 is paid at 150%.
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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