Surgical removal of all three bones in the proximal carpal row — scaphoid, lunate, and triquetrum — to relieve pain and restore wrist function.

Verified May 8, 2026 · 6 sources ↓

Medicare: $577.84
Total RVUs: 17.3
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Name all three bones excised — scaphoid, lunate, and triquetrum — individually in the operative note; a generic reference to 'proximal row bones' is an audit flag.
Specify the surgical approach (dorsal longitudinal, S-shaped incision, etc.); notes that say 'standard approach' invite ADR requests.
Document the indication — SLAC wrist stage, SNAC wrist, Kienböck disease stage, or other degenerative/traumatic diagnosis — with supporting imaging.
Note whether the pisiform was retained; removing it does not upgrade the code but its status should be explicit to avoid coder ambiguity.
Record soft-tissue handling: capsular repair, extensor tendon management, and any wrist denervation performed, since concurrent procedures may be separately billable or bundled.
Confirm laterality (left or right wrist) in both the operative note header and the body of the note to support LT/RT modifier assignment.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25215 describes a proximal row carpectomy in which the surgeon excises the scaphoid, lunate, and triquetrum through a dorsal wrist incision. The pisiform, though anatomically part of the proximal row, is not routinely removed and its excision does not change the code. The procedure is performed for end-stage wrist conditions — most commonly SLAC (scapholunate advanced collapse) wrist, SNAC wrist, Kienböck disease, or severe osteoarthritis — where motion-preserving salvage is preferable to total wrist fusion.

All three bones must be documented as removed to support 25215. Removing only one bone maps to 25210 (single carpal bone excision). If the surgeon also resurfaces or implants the capitate head in the same session, a separate arthroplasty code may apply; consult CPT Assistant February 2019 guidance on proximal row carpectomy with capitate resurfacing before stacking codes. Thumb CMC arthroplasty (25447) on the same hand, same session, requires modifier 51 and solid NCCI edit review.

The 90-day global period covers all routine post-op wrist care, splint changes, and suture removal through day 90. Unrelated procedures in that window need modifier 79; complications requiring a return to the OR for a related issue need modifier 78. Hand surgeons are the dominant billing specialty. Site of service matters: HOPD and ASC payment rates differ materially — see the site-of-service comparison table on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.94
Practice expense RVU	7.85
Malpractice RVU	1.51
Total RVU	17.3
Medicare national rate	$577.84
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	$577.84
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 25215 get rejected.

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

Operative note documents fewer than three proximal row bones removed, triggering downcoding to 25210 or an outright denial.
Missing or vague diagnosis linkage — payers deny when the documented ICD-10 (e.g., M19.031 for primary osteoarthritis of wrist) does not clearly support the need for complete proximal row excision.
Laterality modifier absent (LT or RT), causing claim suspension or rejection by payers that require side identification on upper-extremity surgical codes.
Concurrent procedure (e.g., 25447 thumb CMC arthroplasty) billed without modifier 51, triggering NCCI bundling denial.
Global period conflict — post-op E/M billed without modifier 24 when the visit falls within the 90-day global and is coded as routine follow-up.

Frequently asked questions

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

01Does removing the pisiform in addition to the scaphoid, lunate, and triquetrum change the code?

No. CPT 25215 covers all bones of the proximal row. The pisiform is anatomically part of that row but is not routinely excised in a standard proximal row carpectomy. Adding it does not upgrade to a different code, but document its removal explicitly so the operative note is accurate.

02What code applies if only one carpal bone is removed?

Use 25210 for excision of a single carpal bone. CPT 25215 requires documentation of all three standard proximal row bones — scaphoid, lunate, and triquetrum. Partial removal maps to 25210, not 25215.

03Can 25215 and 25447 (thumb CMC arthroplasty) be billed together on the same hand, same session?

Yes, but append modifier 51 to the lower-valued code and verify NCCI edits. Both procedures are distinct anatomic sites on the same hand, but payers and NCCI editors scrutinize same-session hand bundling closely. Document each procedure separately and confirm no column-one/column-two edit precludes the combination.

04What happens if the surgeon performs capitate resurfacing during the same proximal row carpectomy session?

CPT Assistant (February 2019) addresses proximal row carpectomy with capitate resurfacing as a separate arthroplasty service. Review that guidance before appending an arthroplasty code; the capitate work may or may not be separately reportable depending on what was performed and whether an implant was placed.

05Which ICD-10 codes most commonly pair with 25215?

Frequent pairings include M19.031 (primary osteoarthritis, right wrist), M19.032 (left wrist), M93.1 (Kienböck disease), and SLAC/SNAC wrist documented under M19.0- or post-traumatic arthritis codes (M12.531/M12.532). The diagnosis must clinically justify complete proximal row excision — partial arthritis limited to one bone generally does not support 25215.

06Is modifier 50 appropriate for bilateral proximal row carpectomy?

Bilateral proximal row carpectomy on the same day is exceedingly rare, but if performed, modifier 50 applies per standard bilateral surgery rules. More practically, use LT and RT on separate claim lines if your payer requires that format instead of modifier 50 on a single line.

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 bones excised (scaphoid, lunate, triquetrum), the dorsal approach detail, indication (SLAC/SNAC stage, Kienböck disease), pisiform status, and laterality directly from dictation — then flags the operative note if fewer than three bones are named. That prevents the single most common downcoding path from 25215 to 25210 before the claim ever leaves the practice.

See how Mira captures CPT 25215 documentation