CPT Codes for Arm Fracture Treatment: Closed vs Open

Arm fracture treatment is coded with CPT codes from the musculoskeletal section, chosen by three things: the bone, the part of the bone that is broken, and how the fracture was treated. The treatment options are closed treatment without manipulation, closed treatment with manipulation (reduction), percutaneous fixation, and open treatment. In the 2026 Medicare fee schedule, every arm fracture treatment code below carries a 90-day global period, so the code pays for the initial cast or splint and routine follow-up care as well as the treatment itself.

The rules below are Medicare's, from CMS's global surgery guidance, the Medicare Claims Processing Manual and the National Correct Coding Initiative (NCCI) policy manual. Many commercial payers follow similar rules, but each sets its own policies, so check the payer's policy for the date of service. Payment varies by payer and locality; for Medicare, use the Physician Fee Schedule look-up.

Which CPT codes cover arm fractures?

Each area of the arm has its own family of codes. Described in our own words:

All of these are active codes in the 2026 fee schedule (RVU26D), each with a 090 global period. Check the code's global indicator for the year of service; don't assume it.

How do you choose the right code?

Work through the operative or procedure note:

1. Which bone, and where? The shaft, the upper end or the lower end of the humerus, radius or ulna, and whether one or both forearm bones are broken.
2. How was it treated?
3. Closed, without manipulation: the fracture is immobilized, not realigned.
4. Closed, with manipulation: the bone is realigned without opening the fracture site.
5. Percutaneous fixation: pins or wires placed through the skin, with the fracture site not opened.
6. Open treatment: the fracture site is surgically opened, usually with internal fixation.
7. For the lower end of the radius, whether the fracture extends into the joint and how many fragments were fixed, which the note has to state.

The note has to describe what was done in terms that support the code: "reduced" alone doesn't say whether the site was opened. NCCI adds three rules:

• Closed, percutaneous and open treatment codes for the same fracture site are mutually exclusive. Only one is reported.
• If a closed treatment fails and is converted to open treatment at the same encounter, only the open treatment is reported.
• If one cast or splint treats several closed fractures without manipulation, only one code for closed treatment without manipulation is reported.

What does the fracture care global package include?

For Medicare, a 090 procedure includes the preoperative visit on the day before or the day of treatment (after the decision to treat), the treatment itself and routine follow-up care for 90 days. For fractures, that means:

• The first cast, splint or strapping. Fracture treatment codes include applying it, so casting codes (such as 29065 for a long arm cast or 29125 for a short arm static splint) aren't reported separately.
• Cast removal by the same practice.
• Routine follow-up visits related to the fracture.

It doesn't include:

• X-rays. Diagnostic tests and diagnostic radiology are outside the package and billed separately. See the guide to CPT codes for X-rays.
• Casting supplies. The Medicare Claims Processing Manual says splint and cast supplies used in the office are paid separately; they are reported with HCPCS codes Q4001 to Q4051 (for example Q4010, supplies for an adult fiberglass short arm cast).
• The visit where the decision to operate was made, for a major (090) procedure, billed with modifier 57 when the record supports it.
• Unrelated visits in the global period, with modifier 24, and treatment of complications that needs a return to the operating room.

What if one provider only gives the initial care?

A common case: an urgent care or emergency physician splints the fracture and refers the patient to an orthopedist.

• Initial care only, no definitive treatment: NCCI allows the physician to report an E/M visit, the casting or splinting code and a cast or splint supply code. The visit is reported only if it is significant and separately identifiable, because casting codes are minor procedures with a 000 global period.
• The physician who then treats the fracture reports the fracture treatment code, which includes the casts and follow-up from that point.
• A formal transfer of care after treatment: the treating surgeon bills the fracture code with modifier 54 (surgical care only), and the physician taking over follow-up bills the same code with modifier 55 (postoperative management only). The transfer agreement is kept in the record.

Which ICD-10-CM codes go with arm fracture codes?

Fracture codes in ICD-10-CM specify the bone, the site, the type of fracture, displacement, laterality and a 7th character for the stage of care. Examples from the FY 2027 code set:

• S42.301A: unspecified fracture of the shaft of the right humerus, initial encounter, closed fracture.
• S52.531A: Colles' fracture of the right radius, initial encounter, closed fracture.
• S52.121A: displaced fracture of the head of the right radius, initial encounter, closed fracture.
• S52.531D: the same Colles' fracture at a subsequent encounter with routine healing.

The official guidelines use 7th character "A" while the patient is receiving active treatment for the fracture, and "D" once active treatment is complete and the patient is receiving routine care during healing. Open fractures use other initial-encounter characters. Code the specific fracture the record describes; unspecified codes are for records that don't say more.

Where do arm fracture claims go wrong?

• Treatment type: closed with manipulation billed when the note doesn't describe a reduction, or open treatment billed for a percutaneous pinning.
• Casting billed with fracture care: a casting code on the same claim as the fracture treatment code.
• Global period: routine follow-up visits billed during the 90 days, or unrelated visits missed because staff assumed they were included.
• Split care: no 54 or 55 modifier when care was transferred.
• Diagnosis: the wrong 7th character for the stage of care, or missing laterality. Use RT or LT on the procedure where the payer requires it.

For billing support, see Highview's physician billing service. The guide to orthopedic billing covers the specialty as a whole, and the guide to surgery CPT codes covers global periods and surgical modifiers in more detail.

Sources

• CMS, PFS Relative Value Files, RVU26D: 2026 status and global periods of 23600–23616, 24500–24685, 25500–25609, 29065 and 29125.
• CMS, Medicare NCCI Policy Manual, Chapter 4 (musculoskeletal system, effective January 1, 2026), section G: casting included in fracture treatment, initial care only, cast removal, closed converted to open, mutually exclusive treatment codes, multiple fractures in one cast.
• CMS, Global Surgery booklet, MLN907166: global package, modifiers 24, 25, 54, 55 and 57.
• CMS, Medicare Claims Processing Manual, Chapter 12, section 40.1: services included in and excluded from the global package, including diagnostic radiology and splint and cast supplies.
• CMS, HCPCS quarterly update (October 2026 file): cast supply codes Q4001–Q4051.
• CMS and NCHS, ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027: 7th characters for fractures, laterality.
• CDC/NCHS, FY 2027 ICD-10-CM code descriptions: S42.301A, S52.531A, S52.121A and S52.531D.
• CMS, Search the Physician Fee Schedule.