Open surgical removal of the synovial lining from the wrist joint, performed through a direct arthrotomy incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $464.27
Total RVUs: 13.9
Global, days: 90
Region: Wrist

Drawn from AAPCGenhealthMdclarityCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis driving surgery — specify the inflammatory condition (e.g., rheumatoid arthritis, chronic synovitis) with supporting ICD-10 code
Operative note must state that an arthrotomy was performed — open joint entry, not arthroscopic visualization
Documentation of synovial tissue excision, including extent of synovectomy and anatomic compartments addressed
Laterality documented explicitly (left, right, or bilateral) to support LT/RT/50 modifier use
Conservative treatment history or clinical rationale establishing medical necessity for open versus arthroscopic approach
Anesthesia type (general or regional) and patient positioning documented in the operative note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25105 describes an open arthrotomy of the wrist joint combined with synovectomy — the surgeon incises down to the wrist capsule, opens the joint, and excises the inflamed or diseased synovial membrane. This is the open approach; surgeons and coders should not conflate it with arthroscopic wrist synovectomy, which carries a different code family. The procedure is most often indicated for rheumatoid arthritis or persistent inflammatory synovitis that has failed conservative management, and the diagnosis driving the surgery must be clearly supported in the record.

25105 carries a 90-day global period. All routine post-op visits, wound checks, and splint or cast changes through day 90 are bundled. Services unrelated to the synovectomy — such as management of a comorbid condition — require modifier 24 on the E/M. A same-day arthrocentesis of the same wrist cannot be billed separately per NCCI policy; arthrocentesis of a different joint on the same date may be reported with modifier 59 if documentation supports a distinct service.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.87
Practice expense RVU	6.89
Malpractice RVU	1.14
Total RVU	13.9
Medicare national rate	$464.27
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	$464.27
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 25105 get rejected.

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

Medical necessity not established — missing documentation of failed conservative treatment or inadequate diagnosis specificity
Arthrocentesis of the same wrist billed separately on the same date without recognizing NCCI bundling
Laterality modifier absent or conflicting between the claim and the operative note
Modifier 22 appended without a supporting addendum explaining what made the work substantially greater than typical
Global period violations — routine post-op E/M billed within 90 days without modifier 24 or 79

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 25105 and arthroscopic wrist synovectomy?

25105 is the open approach — the joint is entered through a direct incision. Arthroscopic wrist synovectomy uses a different code. If you used a scope, 25105 is the wrong code and will create an audit exposure if the operative note describes portals rather than an open arthrotomy.

02Can I bill a same-day wrist injection or aspiration alongside 25105?

No. Per NCCI policy, arthrocentesis of the same joint cannot be billed separately when an open or arthroscopic procedure is performed on that joint the same day. If you aspirated a different joint, modifier 59 applies and documentation must confirm a distinct anatomic site.

03Does 25105 require a bilateral modifier if both wrists are done in the same session?

Yes. Bill with modifier 50 on a single line for professional claims. In an ASC, report two lines — one with LT and one with RT. Make sure both operative notes document laterality explicitly.

04What is the global period for 25105, and what does it bundle?

The global period is 90 days. It covers the day-before pre-op visit, the surgery day, and all routine post-op care through day 90 — wound checks, suture removal, splinting, and dressing changes. Unrelated E/M services in that window need modifier 24.

05When is modifier 22 appropriate for 25105?

Only when the work was substantially greater than typical — for example, dense adhesions, prior surgical scarring, or extensive multi-compartment disease requiring significantly more time and effort. You must attach a written addendum; without it, virtually all payers will strip the modifier and reduce payment.

06Which ICD-10 codes most commonly support 25105?

Rheumatoid arthritis with wrist involvement (M05.x3x, M06.x3x) and localized synovitis/tenosynovitis of the wrist (M65.x3x) are the most common payer-accepted diagnoses. The ICD-10 code must specify the wrist and match the operative side; a generic arthritis code without joint specificity is a frequent medical necessity denial trigger.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the surgical approach (open arthrotomy vs. arthroscopic), the specific compartments where synovium was excised, laterality, anesthesia type, and the clinical indication from dictation. That prevents the most common 25105 denial: a vague operative note that fails to distinguish open synovectomy from arthroscopic work or that omits extent of tissue removal — both audit red flags.

See how Mira captures CPT 25105 documentation