Surgical · Wrist

Open arthrotomy of the wrist joint performed specifically to obtain tissue for biopsy and diagnostic analysis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $347.04
Work RVU: 3.92
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityEmednyAbos

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify the joint entered — radiocarpal, midcarpal, or distal radioulnar — not just 'wrist joint'.
Document the surgical approach and incision location in the operative note.
Confirm tissue specimen was sent for pathologic examination and record the pathology order.
State the clinical indication driving the biopsy (e.g., suspected infection, inflammatory arthropathy, neoplasm).
Document that the primary purpose was biopsy, not exploration or synovectomy, to justify 25100 over 25101 or 25105.
Record laterality (left vs. right wrist) explicitly in the operative note and on the claim.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25100 describes an open wrist arthrotomy in which the surgeon incises into the wrist joint capsule to obtain a tissue biopsy specimen. This is a distinct code from 25101 (joint exploration with or without biopsy) and 25105 (arthrotomy with synovectomy). When the primary purpose of the arthrotomy is biopsy — not exploration, loose body removal, or synovectomy — 25100 is the correct code. If the operative note documents exploration or additional intra-articular work beyond biopsy, consider 25101 instead.

The 90-day global period applies. That window covers the day-before visit, the procedure itself, and all routine postoperative management through day 90. Any E/M visit or procedure during the global period for an unrelated condition requires modifier 24 or 79, respectively. For a related unplanned return to the OR during the global period, use modifier 78.

Site of service matters: the HOPD and ASC facility payments differ significantly — see the site-of-service comparison table on this page. Soft-tissue biopsy codes 25065 and 25066 are not interchangeable with 25100; those codes address subcutaneous or subfascial soft tissue, not the joint itself. Laterality modifiers LT and RT are expected by most payers; omitting them is a common clean-claim failure point.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (3.92) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.39) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.92
Practice expense RVU	5.63
Malpractice RVU	0.84
Total RVU	10.39
Medicare national rate	$347.04
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$347.04
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25100 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing laterality modifier — most payers require LT or RT on wrist procedure codes.
Code billed during an active global period of a prior wrist procedure without modifier 78 or 79.
25100 upcoded or downcoded to 25101 or 25065 when operative note doesn't match the biopsy-only intent.
ICD-10 diagnosis does not support an open biopsy (e.g., no documented suspicion of infection, inflammatory disease, or neoplasm).
FNA biopsy (10004–10021) billed on the same day for the same lesion — NCCI prohibits reporting both.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01When should I use 25100 versus 25101?

Use 25100 when the sole purpose of the arthrotomy is to obtain a biopsy specimen. Use 25101 when the surgeon also explores the joint, removes a loose body, or performs additional intra-articular work. The operative note must reflect the distinction — audit teams flag notes that describe exploration billed under 25100.

02Can 25100 be billed with soft-tissue biopsy codes 25065 or 25066 on the same day?

Only if a separate, distinct soft-tissue lesion was biopsied in addition to the joint biopsy. Document that the two specimens are from different anatomic sites and append modifier 59 (or XS) to the secondary code. NCCI rules prohibit billing both for the same lesion.

03Is modifier 50 appropriate for 25100?

Bilateral wrist joint biopsies at the same session are uncommon, but if performed, report with modifier 50 on a single claim line for Medicare. ASC claims should use separate LT and RT lines per CMS NCCI policy.

04Does the 90-day global period affect follow-up E/M billing?

Yes. Routine postoperative visits within 90 days are bundled. Bill modifier 24 on an E/M only if the visit is for a condition unrelated to the wrist biopsy. Document the unrelated diagnosis clearly — auditors look for a distinct ICD-10 code on that line.

05What diagnosis codes typically support 25100?

Common supporting diagnoses include septic arthritis of the wrist, inflammatory arthropathy with wrist involvement, synovial lesions, and suspected neoplasm of joint structures. A vague pain diagnosis alone is unlikely to justify an open surgical biopsy and will draw medical necessity scrutiny.

06Can 25100 be billed at the same encounter as a wrist arthroscopy code?

Generally no — if an arthroscopic approach was used, the appropriate code is the arthroscopic biopsy code (29840), not 25100. Reserve 25100 for procedures performed through an open incision. Billing both an open arthrotomy and an arthroscopy code for the same joint on the same day will trigger NCCI scrutiny.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the joint compartment entered, surgical approach, indication for biopsy, specimen disposition to pathology, and explicit laterality from the surgeon's dictation. This prevents the two most common 25100 denials: missing laterality and operative notes that support 25101 or 25065 instead of 25100.

See how Mira captures CPT 25100 documentation