CPT Code Overview

CPT 25605 describes the closed treatment of a distal radial fracture (for example, Colles or Smith type) or epiphyseal separation with manipulation. The code includes closed treatment of an associated ulnar styloid fracture when performed. This is an orthopedic surgical procedure typically performed in an office or outpatient surgical setting such as an office (POS 11).

Clinical Context

A adult patient presents to an outpatient orthopedic clinic after a fall onto an outstretched hand with acute wrist pain, swelling, and deformity. Evaluation includes history, focused physical exam, and wrist radiographs confirming a distal radial fracture (e.g., Colles or Smith type) with or without an associated ulnar styloid fracture. The treating orthopaedic surgeon or orthopaedic hand specialist discusses closed reduction and immobilization; the procedure is performed in the office or outpatient surgical setting under appropriate analgesia or local/regional anesthesia. Post-reduction radiographs are obtained to confirm alignment and a cast or splint is applied. Follow-up visits occur to monitor healing during the postoperative period.

Coding Specifications

Modifier 58 - Staged or related procedure or service by the same physician during the postoperative period

• Use when the current procedure is the planned staged or more definitive procedure that was anticipated at the time of the initial procedure and occurs during the global postoperative period.

Modifier 59 - Distinct procedural service

• Use when reporting a procedure that is not normally reported together with another procedure, but is appropriate under the circumstances (e.g., procedures performed on different limbs or other distinct service circumstances). This modifier is used to override CCI edits when clinically supported.

Modifier LT - Left side

• Use when the procedure is performed on the left wrist/radius.

Modifier RT - Right side

• Use when the procedure is performed on the right wrist/radius.

Associated provider taxonomies:

• 207X00000X — Orthopaedic Surgery

• 207XX0004X — Orthopaedic Trauma

• 207XX0801X — Orthopaedic Hand Surgery

Related Diagnoses

S52.501A — Unspecified fracture of the lower end of right radius, initial encounter for closed fracture

• Clinical relevance: Describes a closed distal radius fracture on the right side that may be treated with closed reduction and casting or manipulation (25605).

S52.502A — Unspecified fracture of the lower end of left radius, initial encounter for closed fracture

• Clinical relevance: Describes a closed distal radius fracture on the left side appropriate for closed treatment and manipulation (25605).

S52.509A — Unspecified fracture of the lower end of unspecified radius, initial encounter for closed fracture

• Clinical relevance: Used when side is not specified in documentation; represents a closed distal radius fracture that may be managed with closed reduction and manipulation (25605).

S52.531A — Colles' fracture of right radius, initial encounter for closed fracture

• Clinical relevance: Specific distal radial fracture pattern (Colles') on the right commonly treated with closed manipulation and immobilization (25605).

S52.532A — Colles' fracture of left radius, initial encounter for closed fracture

• Clinical relevance: Specific distal radial fracture pattern (Colles') on the left commonly treated with closed manipulation and immobilization (25605).

Related CPT Codes

25606 - Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation

• This code describes closed reduction with percutaneous pins or skeletal fixation and is an alternative or adjunct to the closed treatment with manipulation reported by 25605.
• 25606 is commonly used instead of 25605 when percutaneous fixation is performed to maintain reduction.
• 25605 and 25606 are related in the clinical workflow: 25605 represents closed reduction and immobilization with manipulation only; 25606 represents cases where percutaneous fixation is added to maintain fixation.
• These codes may be selected based on the fracture stability and whether skeletal fixation is performed.

National commercial averages (BUCA) have a mean allowed rate of $735.63 for CPT 25605, which is modestly higher than the Medicare mean of $652.21. UnitedHealth Group and Cigna report the highest commercial means at $962.63 and $896.76 respectively, while Aetna is lower at $595.72.

Dispersion (P75 minus P25) varies across payers: UnitedHealth Group shows one of the widest spreads at $554.67 (P75 $1,159.00 minus P25 $604.33), followed by Cigna with $496.75. Aetna and Medicare are the tightest, with ranges of $324.67 and $70.00 respectively. The table and chart below present the full breakdown of mean rates and percentiles by payer.