No office rate
This code describes repair of both forearm bones without graft. Use 25426 when the documented service includes the graft-related reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
25426 Forearm bone repair Medicare reimbursement rates in Virginia
Reports graft-assisted surgical repair of a radius and ulna nonunion or malunion when both forearm bones require reconstruction. Compare 25426 office and facility rates across CMS payment localities in Virginia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 25426 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$987.18–$1136.06
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 25426: Graft repair of radius and ulna nonunion
Reports graft-assisted surgical repair of a radius and ulna nonunion or malunion when both forearm bones require reconstruction.
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.
CMS billing rules for 25426
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.04 · 52%
- Practice expense (office) RVU11.30 · 37%
- Malpractice RVU3.41 · 11%
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.
25426 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
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.
No office rate
This is the graft-repair sibling for one bone, either the radius or ulna; 25426 is for repair involving both.
Compare 25426 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$1136.06
Virginia →
Office / nonfacility
Unavailable
Facility
$987.18
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,45125415,,Repair radius & ulna,A,,13.46,10.48,NA,10.48,,2.87,26.81,26.81,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45225420,,Repair/graft radius & ulna,A,,16.61,11.84,NA,11.84,,3.54,31.99,31.99,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45325425,,Repair/graft radius or ulna,A,,13.38,10.45,NA,10.45,,2.85,26.68,26.68,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45425426,,Repair/graft radius & ulna,A,,16.04,11.30,NA,11.30,,3.41,30.75,30.75,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45525430,,Vasc graft into carpal bone,A,,9.47,9.33,NA,9.33,,2.02,20.82,20.82,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45625431,,Repair nonunion carpal bone,A,,10.62,9.24,NA,9.24,,2.26,22.12,22.12,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,45725440,,Repair nonu scphd carpl b1,A,,10.41,8.69,NA,8.69,,2.00,21.10,21.10,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00