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See a sample rate comparisonCPT 25609 Fee Schedule
Medicare rates as of October 2026
CPT 25609 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Open Treatment Of Distal Radia, Open Treatment Of Distal Radial Intra-Articular Fracture Or Epiphyseal Separation With Internal Fixation Of 3 Or More Fragments
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600960Sign up to view all 10 |
| Medicare Fee Schedule | $968.29 national non-facility rate (2026)View Medicare rates for 25609 |
| Medicaid Fee Schedule | $769.98 median of the 8 states in the free previewView Medicaid rates for 25609 |
National average reimbursement for CPT 25609 by major payers:
$1,370.17
BCBS / Anthem
$1,397.29
UnitedHealthcare
$1,486.24
Aetna
$1,728.40
Cigna
Compare published rates across providers.
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CPT 25609
5 of 25 sample ratesHigher to lower in this preview
Columbia Hospital At Medical City Dallas Subsidiary Lp, Medical City Dallas
$21,000.00Published ratePhysicians Surgery Center Of Chattanooga, LLC, Physicians Surgery Center Of Chattanooga
Physicians Surgery Center Of Chattanooga LLC
$6,588.00Published rateAnnapolis Endoscopy Center LLC
$3,826.00Published rateMoses Cone Medical Services Inc., Lebauer Endoscopy Center
Moses Cone Medical Services Inc
$2,715.00Published rateCourtney Merkel
Deaconess Hospital Inc
$840.76Published rate
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See a sample payer proposalCPT 25609 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 25609. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 25600-CPT | Treat Fracture Radius Ulna, Closed Treatment Of Distal Radial Fracture Eg Colles Or Smith Type Or Epiphyseal Separation Includes Closed Treatment Of Fracture Of Ulnar Styloid When Performed Without Manipulation |
| 25605-CPT | Treat Fracture Radius Ulna, Closed Treatment Of Distal Radial Fracture Eg Colles Or Smith Type Or Epiphyseal Separation Includes Closed Treatment Of Fracture Of Ulnar Styloid When Performed With Manipulation |
| 25606-CPT | Stabilize A Broken Wrist, Immobilization Of A Broken Wrist Using Wire Inserted Through The Skin To Hold The Bone In Place. A Cast Is Applied. |
| 25609-CPT | Open Treatment Of Distal Radia, Open Treatment Of Distal Radial Intra-Articular Fracture Or Epiphyseal Separation With Internal Fixation Of 3 Or More Fragments |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25609. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25609 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
What APC is CPT 25609 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 25609 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 25609 in an ambulatory surgery center?
CMS lists CPT 25609 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 25609?
Hospital price transparency files list CPT 25609 under these revenue codes: including 0360, 0960, 0975, 0450 and 0989. A revenue code names the hospital department or charge category for the line; it does not change what the service is.