Surgical excision of part of the distal ulna, including procedures such as the Darrach resection or matched resection at the wrist end of the forearm.

Verified May 8, 2026 · 8 sources ↓

Medicare: $410.50
Total RVUs: 12.29
Global, days: 90
Region: Wrist

Drawn from CMSMdclarityAAPCEatonhandGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must identify the specific resection technique by name (Darrach, matched resection, or hemiresection) — generic language like 'standard distal ulna excision' invites audit scrutiny.
Document the clinical indication clearly: arthritis, malunion, DRUJ instability, rheumatoid destruction, or tumor — ICD-10 must map directly to the procedure.
Specify the extent of bone removed (partial vs. complete) and any soft tissue stabilization performed, since that determines whether 25240 is the correct code versus a more comprehensive procedure.
If billing same-day with 25332 (wrist arthroplasty) or any other wrist procedure, the note must establish that the ulna excision was a distinct service beyond what the companion code already includes.
Pre-operative imaging (X-ray or MRI) in the record confirming structural pathology at the distal ulna is required to support medical necessity.

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 25240 covers partial removal of the distal ulna — the wrist-side end of the forearm bone — performed to relieve pain and restore wrist mechanics. Classic indications include distal radioulnar joint arthritis, post-traumatic malunion, rheumatoid wrist destruction, and chronic instability. The Darrach procedure (full distal ulna resection) and matched resection are the most common named variants billed under this code.

The code carries a 90-day global period. All routine post-op visits, wound checks, and suture removal through day 90 are included in the global package. Anything genuinely unrelated to the wrist procedure in that window requires modifier 24 (E/M) or 79 (unrelated surgery). Note that 25240 is bundled as a component of wrist arthroplasty (25332) under NCCI — you cannot unbundle the distal ulna excision when it is integral to the arthroplasty; append modifier 59 or an X-modifier only when the excision is performed as a distinct, separate procedure with clear clinical justification documented in the operative note.

Site of service matters: HOPD and ASC payments differ substantially (see the site-of-service comparison table). When the procedure is performed bilaterally — uncommon but documented in rheumatoid patients — append modifier 50 and confirm payer policy, as some commercial payers require separate line items with LT/RT instead.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.18
Practice expense RVU	6.1
Malpractice RVU	1.01
Total RVU	12.29
Medicare national rate	$410.50
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	$410.50
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 25240 get rejected.

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

NCCI bundling with 25332 (wrist arthroplasty) — distal ulna excision is considered a component of that procedure and denies without a valid modifier and distinct documentation.
ICD-10 mismatch — diagnosis code reflecting only soft-tissue wrist pain without documented osseous pathology fails medical necessity review for a bone excision procedure.
Incomplete operative report — notes that omit the surgical approach, extent of resection, and specific technique are flagged in audit and frequently result in post-payment clawback.
Missing laterality modifier on payers that require LT or RT for unilateral upper-extremity procedures, triggering edit-based denials.
Global period conflicts — follow-up E/M visits billed within 90 days without modifier 24, or a related return procedure billed without modifier 78, deny automatically.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Is the Darrach procedure always billed as 25240?

Yes. The Darrach procedure — complete resection of the distal ulna — and partial resection variants (including matched resection) are both captured under 25240. The code covers the spectrum from partial to complete distal ulna excision at the wrist.

02Can I bill 25240 with 25332 (wrist arthroplasty)?

Not routinely. NCCI bundles 25240 as a component of 25332. If the distal ulna excision was performed as a separate, distinct procedure beyond the arthroplasty work — with clear documentation supporting that distinction — you can append modifier 59 or XS. Without that documentation, the claim denies.

03What modifiers are needed for a bilateral case?

Append modifier 50 for bilateral billing on the same line, or use LT and RT on separate lines, depending on payer preference. Confirm requirements before submitting — Medicare and most commercial payers differ on line-item versus modifier 50 formatting.

04A patient returns 45 days post-op for an unrelated radius fracture repair. What modifier applies?

Modifier 79 — unrelated procedure by the same physician during the post-operative period. Do not use modifier 78, which applies only to a return to the OR for a complication or issue related to the original 25240 procedure.

05What ICD-10 codes most commonly support 25240?

Common supporting diagnoses include distal radioulnar joint arthritis (M19.031/M19.032), post-traumatic deformity of the wrist (M21.531/M21.532), rheumatoid arthritis with wrist involvement (M05.631/M05.632), and distal ulna fracture malunion (M84.531/M84.532). The diagnosis must reflect osseous pathology — soft-tissue wrist pain codes alone will fail medical necessity.

06Does 25240 have a global period, and what does that include?

25240 carries a 90-day global period covering the day-before visit, the procedure, and all routine post-op care through day 90. Separate billing for wound checks, suture removal, or routine follow-up in that window will deny. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated surgical procedures during the global.

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 resection technique (Darrach, matched, hemiresection), the extent of bone removed, the surgical approach, and the clinical indication from dictation — then flags when the note language is generic enough to trigger an audit or NCCI bundle dispute with 25332. That prevents the most common post-payment review finding: an operative report that doesn't independently justify the ulna excision as a distinct service.

See how Mira captures CPT 25240 documentation