How much does Medicare pay for CPT 25609?

Medicare allowed an average of $2445.40 per service and paid $1946.49 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $10,440, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 25609?

Treatment of 3 or more broken lower forearm bone pieces on thumb side inside wrist joint with placement of stabilizing device. It was billed 7,916 times to 7,849 Medicare beneficiaries by 476 providers in 2024.

Does 25609 pay differently in an office than a hospital?

Yes. The allowed amount averaged $932.41 in an office setting and $2458.70 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 25609 most?

Ambulatory Surgical Center, with 3,336 services from 176 clinicians. Next are Hand Surgery, Orthopedic Surgery, Physician Assistant.

CPT 25609

Treatment of 3 or more broken lower forearm bone pieces on thumb side inside wrist joint with placement of stabilizing device

$2445.40Medicare-allowed amount per service, averaged across 7,916 services

Providers submitted

$10,440

Asking price, not received

Medicare allowed

$2445.40

The fee schedule figure

Medicare paid

$1946.49

Balance is patient coinsurance

Providers submitted an average of $10,440 for this code and Medicare allowed $2445.40 — 4.3× 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 $1946.49 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $932.41
Hospital / facility: $2458.70

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 69 services were billed in an office setting and 7,847 in a facility.

Services: 7,916
Beneficiaries: 7,849
Providers billing it: 476
Total allowed: $19,357,786

What Medicare pays for CPT 25609

Across 7,916 services billed by 476 providers to 7,849 beneficiaries, Medicare allowed an average of $2445.40 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 25609

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	3,336	3,296	$4567.97	176
Hand Surgery	2,010	1,991	$1065.73	126
Orthopedic Surgery	1,664	1,658	$1057.26	112
Physician Assistant	757	756	$143.58	52
Plastic and Reconstructive Surgery	57	56	$1061.00	3
Nurse Practitioner	52	52	$140.52	4
General Surgery	25	25	$1075.03	2
Sports Medicine	15	15	$950.98	1

25609 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
California	1,223	$2794.50	$1849.07	68
Florida	1,047	$2177.65	$1798.62	60
Illinois	470	$2416.60	$1898.55	30
New York	410	$3172.63	$2277.40	26
Pennsylvania	361	$2698.40	$2116.60	17
North Carolina	341	$2545.55	$2171.79	23
Massachusetts	323	$1719.40	$1342.30	16
Texas	295	$2019.54	$1720.89	20
Maryland	284	$2906.73	$2308.61	16
Virginia	248	$2042.07	$1706.43	13
Arizona	211	$2611.76	$2137.80	12
Tennessee	207	$2562.84	$2315.35	11
New Jersey	202	$2358.45	$1818.37	14
Ohio	202	$2294.07	$1952.16	13
Michigan	187	$2213.74	$1824.67	12
Mississippi	141	$2361.64	$2126.03	7
South Carolina	141	$1348.11	$1139.08	8
Nebraska	138	$1425.97	$1200.02	9
Georgia	135	$2913.50	$2470.17	8
Louisiana	133	$1584.71	$1388.00	8
Colorado	117	$2456.03	$1937.27	9
Oregon	115	$2616.35	$2014.25	7
Delaware	100	$2667.04	$2116.94	7
Washington	95	$3230.42	$2367.26	6
Oklahoma	92	$876.34	$734.41	7
Indiana	74	$3199.33	$2634.67	6
Rhode Island	60	$2699.28	$2143.12	4
Kentucky	60	$1610.07	$1330.13	4
Minnesota	56	$3694.71	$2925.21	4
New Hampshire	54	$1801.84	$1479.14	4
Connecticut	49	$4837.71	$3572.40	3
Arkansas	45	$2621.71	$2251.01	3
Missouri	45	$975.41	$839.31	2
Iowa	39	$3064.36	$2628.46	3
Wisconsin	36	$2328.56	$1888.19	3
Alabama	29	$553.80	$478.85	2
Montana	23	$4227.22	$3609.26	2
Nevada	22	$2820.81	$2125.29	2
South Dakota	22	$948.45	$806.63	1
New Mexico	19	$4027.48	$3561.71	1
Alaska	18	$4890.06	$3608.32	1
Utah	13	$4351.74	$3594.72	1
District of Columbia	12	$4584.75	$3609.22	1
Idaho	11	$957.12	$827.37	1
Guam	11	$1080.34	$832.31	1

Related codes

25600Closed treatment of broken forearm (radius) bone at the wrist area on$353.35

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.