How much does Medicare pay for CPT 25600?

Medicare allowed an average of $353.35 per service and paid $274.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1394.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 25600?

Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation. It was billed 5,365 times to 5,335 Medicare beneficiaries by 319 providers in 2024.

Does 25600 pay differently in an office than a hospital?

Yes. The allowed amount averaged $354.42 in an office setting and $334.01 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 25600 most?

Orthopedic Surgery, with 2,488 services from 154 clinicians. Next are Hand Surgery, Physician Assistant, Nurse Practitioner.

CPT 25600

Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation

$353.35Medicare-allowed amount per service, averaged across 5,365 services

Providers submitted

$1394.59

Asking price, not received

Medicare allowed

$353.35

The fee schedule figure

Medicare paid

$274.16

Balance is patient coinsurance

Providers submitted an average of $1394.59 for this code and Medicare allowed $353.35 — 3.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $274.16 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $354.42
Hospital / facility: $334.01

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,083 services were billed in an office setting and 282 in a facility.

Services: 5,365
Beneficiaries: 5,335
Providers billing it: 319
Total allowed: $1,895,723

What Medicare pays for CPT 25600

Across 5,365 services billed by 319 providers to 5,335 beneficiaries, Medicare allowed an average of $353.35 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 25600

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	2,488	2,472	$357.49	154
Hand Surgery	2,266	2,257	$364.70	127
Physician Assistant	438	434	$289.13	27
Nurse Practitioner	92	91	$283.47	5
Sports Medicine	38	38	$332.58	3
Plastic and Reconstructive Surgery	32	32	$329.86	2
Family Practice	11	11	$360.45	1

25600 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	681	$352.01	$269.46	39
New York	659	$405.24	$273.63	36
Pennsylvania	487	$355.56	$267.26	27
New Jersey	462	$374.92	$272.20	25
Massachusetts	382	$369.22	$269.34	20
Illinois	370	$352.78	$262.53	23
Ohio	251	$308.01	$255.46	17
California	196	$376.48	$262.72	10
Maryland	182	$354.93	$248.86	10
South Carolina	168	$311.95	$253.74	9
Michigan	167	$345.27	$266.15	13
Virginia	160	$348.13	$264.23	10
Indiana	135	$314.47	$267.34	9
Connecticut	128	$371.43	$265.95	9
Iowa	123	$321.20	$266.02	9
Arizona	105	$323.85	$256.60	7
Missouri	83	$322.50	$264.35	6
New Mexico	59	$277.05	$227.22	2
Kansas	47	$318.75	$271.19	3
Louisiana	46	$346.98	$256.68	4
Oklahoma	45	$300.15	$252.78	3
Kentucky	44	$310.85	$238.23	3
Texas	43	$316.04	$241.52	3
Tennessee	41	$305.79	$231.39	2
North Carolina	40	$317.24	$258.44	3
District of Columbia	38	$360.03	$275.09	1
Nebraska	37	$301.94	$235.52	2
Alabama	33	$314.76	$266.43	2
Georgia	25	$338.50	$257.80	2
Mississippi	24	$316.48	$272.63	2
Colorado	22	$349.11	$250.89	2
Delaware	17	$325.79	$275.69	1
Washington	15	$385.35	$243.97	1
Wisconsin	14	$325.51	$262.90	1
North Dakota	13	$275.77	$209.63	1
Hawaii	12	$377.65	$276.92	1
West Virginia	11	$272.62	$220.31	1

Related codes

25609Treatment of 3 or more broken lower forearm bone pieces on thumb side$2445.40

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.