Sequestrectomy of the forearm and/or wrist — surgical removal of necrotic or infected bone tissue (sequestrum) from the radius, ulna, or wrist, typically performed for osteomyelitis or bone abscess.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $502.35
- Total RVUs
- 15.04
- Global, days
- 90
- Region
- Wrist
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Specify the bone(s) operated on (radius, ulna, and/or specific carpal bone)
- Document the clinical indication — osteomyelitis, bone abscess, or other source of bone necrosis — with imaging or lab correlation
- Describe the extent of bone excision and debridement performed, including any saucerization or craterization technique used
- Record intraoperative cultures obtained and any concurrent soft-tissue debridement
- Note whether fluoroscopy or other imaging guidance was used intraoperatively
- Include pathology submission details for the excised bone specimen to support medical necessity
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 25145 covers open surgical removal of a bone sequestrum from the forearm (radius and/or ulna) and/or wrist. The procedure addresses dead or infected bone — most commonly resulting from osteomyelitis or a bone abscess — by excising the necrotic fragment and debriding the surrounding diseased tissue. It falls under the partial bone excision family (sequestrectomy, craterization, saucerization, diaphysectomy) and carries a 90-day global period.
The 90-day global covers the operative day, the day-before visit, and all routine post-op management through day 90. Wound checks, dressing changes, and suture removal within that window are bundled. Use modifier 24 for unrelated E&M visits and modifier 78 for an unplanned return to the OR for a related complication during the global. Effective January 1, 2024, CMS added 25145 to the list of CPT codes billable with HCPCS device code C1602 in the hospital outpatient setting when an applicable pass-through device is used — a claim-level requirement that catches HOPD billers off guard.
Document the specific bone(s) involved (radius, ulna, carpal), the extent of resection, cultures obtained, and any concurrent wound debridement. Payers scrutinize whether the level of bone involvement justifies the sequestrectomy code versus a simple debridement. Pathology submission of the excised bone fragment strengthens medical necessity and provides audit-proof documentation of the infected or necrotic tissue.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 6.38 |
| Practice expense RVU | 7.32 |
| Malpractice RVU | 1.34 |
| Total RVU | 15.04 |
| Medicare national rate | $502.35 |
| 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 | $502.35 |
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 25145 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established — missing pre-op imaging (X-ray, MRI, or bone scan) confirming osteomyelitis or bone abscess
- Operative note describes only soft-tissue debridement without clear documentation of bone removal, triggering downcoding
- HOPD claims missing required HCPCS device code C1602 when a qualifying pass-through device was used, per CMS CR 13488
- Global period violations — routine post-op wound care billed separately within the 90-day global without appropriate modifier
- Concurrent debridement or bone biopsy codes billed without modifier 59 or XS when performed at a separate anatomic site
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What is the global period for CPT 25145?
02Can 25145 be billed with a bone biopsy code at the same encounter?
03What is HCPCS C1602 and when does it apply to 25145?
04Is 25145 appropriate for debridement of osteomyelitis without formal sequestrectomy?
05How should bilateral forearm sequestrectomies be coded?
06Can an E&M be billed on the same day as 25145?
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 specific bone(s) excised (radius, ulna, carpal), the operative technique (sequestrectomy, saucerization, or craterization), the clinical indication (osteomyelitis, bone abscess), cultures obtained, and extent of debridement directly from dictation. That prevents the most common audit flag for 25145 — operative notes that document wound irrigation without clearly describing bone removal, which gives payers grounds to downcode to a soft-tissue debridement code.
See how Mira captures CPT 25145 documentation