Open surgical removal of one or more carpal (wrist) bones through a direct incision, excluding the pisiform.

Verified May 8, 2026 · 5 sources ↓

Medicare: $467.28
Total RVUs: 13.99
Global, days: 90
Region: Wrist

Drawn from CMSCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Name the specific carpal bone(s) excised — do not write 'wrist bone removed'
Document the surgical approach (dorsal, volar, or combined) and incision location
Record the pathology or indication driving excision (e.g., avascular necrosis, coalition, post-traumatic arthritis)
Note neurovascular structures identified and protected during dissection
If bone graft or ligamentous reconstruction was performed, detail separately to support additional coding or modifier 22
Laterality must be explicit — left, right, or bilateral — in both the operative note and the order

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25210 covers open excision of a single carpal bone. The procedure is performed through a dorsal or volar incision with direct visualization, dissection around neurovascular structures, and complete removal of the targeted bone — most commonly the lunate (in Kienböck disease), scaphoid, or a carpal coalition bone. It carries a 90-day global period, meaning all routine post-op visits through day 90 are bundled. Anything unrelated to the wrist excision billed during that window requires modifier 24 or 25.

If more than one carpal bone is removed during the same operative session, 25215 (excision of all carpals) may better capture the work. Do not bill 25210 twice for bilateral wrist procedures — use modifier 50 or laterality modifiers LT/RT. When bone graft or soft-tissue reconstruction adds substantial documented complexity, modifier 22 with a supporting operative note letter is appropriate. Fluoroscopy used for intraoperative confirmation is not separately reportable when it's a routine component of the approach.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.97
Practice expense RVU	6.87
Malpractice RVU	1.15
Total RVU	13.99
Medicare national rate	$467.28
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	$467.28
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 25210 get rejected.

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

Missing or vague laterality documentation causing claim-level mismatch with modifier or ICD-10
Operative note describes 'partial excision' without confirming complete bone removal, triggering a scope-of-service query
Unbundling 25210 with 25215 on the same date without a distinct anatomic site justification
Separate billing of intraoperative fluoroscopy when it is considered a routine component of the open carpal excision
Global period violation — post-op visit billed without modifier 24 when the visit is for an unrelated condition within the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01When should I use 25210 vs. 25215?

25210 is for excision of a single carpal bone. If all or nearly all carpals are removed in the same session, 25215 is the correct code. Don't bill 25210 multiple times to describe removal of several bones — that's unbundling.

02Can I bill fluoroscopy separately with 25210?

No. Intraoperative fluoroscopy used for routine visualization during an open carpal excision is considered a component of the procedure. Separate billing of fluoroscopy codes in this context will deny under NCCI bundling policy.

03What modifier do I use for a bilateral carpal bone excision on the same date?

Append modifier 50 for true bilateral procedures reported on a single line, or use LT and RT on separate lines depending on your payer's preference. Confirm with the specific MAC or commercial payer — billing conventions differ.

04Does the 90-day global period affect how I bill an E/M after surgery?

Yes. Any E/M visit related to the wrist excision within 90 days is bundled — do not bill it separately. If the visit is for a completely unrelated condition, append modifier 24 and document the unrelated diagnosis clearly.

05Can 25210 be performed in an ASC setting?

Yes. The procedure is eligible for ASC reimbursement. The ASC facility payment rate differs from the HOPD rate — see the Site of Service comparison table on this page for current 2026 figures.

06When is modifier 22 appropriate for 25210?

Use modifier 22 when documented operative complexity substantially exceeds the typical excision — for example, severe adhesions, prior failed surgery, or concurrent soft-tissue reconstruction. Attach a cover letter to the claim explaining the added work. Without supporting documentation, the additional payment request will be denied.

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 carpal bone excised by name, the surgical approach, laterality, and the indication from dictation — eliminating the generic 'wrist bone removed' language that triggers post-payment audit flags. It also flags when reconstruction or graft work is dictated so the coder can evaluate modifier 22 before the claim drops.

See how Mira captures CPT 25210 documentation