Injection · Wrist

Injection of contrast material into the wrist joint to enable radiographic imaging (arthrography) of the wrist structures.

Verified May 8, 2026 · 5 sources ↓

Medicare: $187.71
Total RVUs: 5.62
Global, days: 0
Region: Wrist

Drawn from CMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Clinical indication for wrist arthrography — specific symptom, diagnosis, or surgical planning rationale
Laterality documented explicitly (left, right, or bilateral) in procedure note
Injection technique described: approach, needle gauge, contrast agent used, volume injected
Provider attestation of direct participation or supervision level, per payer requirements
Pre-procedure timeout or consent note if payer or facility requires it
Post-injection patient status and any immediate adverse reactions noted

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25246 covers the injection of contrast agent into the wrist for arthrographic imaging — the procedural component only. The code is used when a physician or qualified provider performs the intra-articular or periarticular injection that facilitates wrist x-ray or fluoroscopic arthrography. It carries a 000-day global period, meaning no pre- or post-operative visits are bundled and each date of service stands alone.

The imaging component itself is billed separately. When fluoroscopic guidance is used during needle placement, 77002 is commonly reported alongside 25246 — but verify NCCI PTP edits before billing both, as bundling rules apply. The code appears most frequently on claims from family practice, anesthesiology, and hand surgery providers per CMS PUF data, which reflects its use across diagnostic workups for wrist pain, instability, and ligamentous pathology.

Laterality modifiers LT and RT are essential — payers expect them on unilateral wrist procedures. Bilateral injection (modifier 50) is uncommon but reportable when clinically justified and documented. Because the global period is 000, modifier 25 on a same-day E/M is required only if a separately identifiable evaluation and management service occurred and is being billed.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.41
Practice expense RVU	4.07
Malpractice RVU	0.14
Total RVU	5.62
Medicare national rate	$187.71
Global period	0 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	$187.71

Common denial reasons

The recurring reasons claims for CPT 25246 get rejected.

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

Missing laterality modifier — LT or RT absent, triggering payer edit
Imaging code billed without verifying NCCI bundling against 25246 on same date
Lack of documented medical necessity — vague diagnosis codes without supporting clinical rationale
Supervision level mismatch when non-physician performed injection under physician billing
Duplicate claim or MUE exceeded if bilateral procedure not coded with modifier 50 instead of two line items

Frequently asked questions

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

01Do I need a laterality modifier on 25246?

Yes. Append LT or RT on every claim. Most payers will reject or suspend a wrist injection claim without explicit laterality. Bilateral same-session injections use modifier 50 on a single line.

02Can I bill 77002 (fluoroscopic guidance) with 25246?

Often yes, but check current NCCI PTP edits before submitting both. When fluoroscopy is used for needle placement during wrist arthrography, 77002 is the appropriate add-on, and a modifier may be required to bypass the edit depending on your MAC.

03What is the global period for 25246?

Zero days. There is no pre- or post-operative period bundled into this code. Each date of service is independent, and a same-day E/M can be billed with modifier 25 if a separately identifiable service occurred.

04Is 25246 used for MRI arthrography injections as well as x-ray arthrography?

The CMS short descriptor says 'injection for wrist x-ray,' but the code is also reported for wrist MR arthrography injections in practice. Confirm with your MAC and document the imaging modality ordered, since some payers scrutinize coding when MRI rather than fluoroscopy follows.

05If the same physician repeats the injection on the same date, which modifier applies?

Use modifier 76 for a repeat injection by the same physician on the same date. Modifier 77 applies if a different physician performs the repeat. Document the clinical reason the injection was repeated.

06Can 25246 be billed during the post-op period of a wrist surgery?

If the arthrography injection is unrelated to the prior surgery, use modifier 79. If it is related to the prior procedure (for example, evaluating a complication), use modifier 78. Do not bill without a modifier in an active global period — the claim will deny.

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 injection site (specific wrist compartment), laterality, contrast agent and volume, needle placement technique, and the clinical indication driving the arthrogram. That detail directly populates the procedure note fields payers audit most — preventing denials for missing laterality and unsupported medical necessity on the same claim.

See how Mira captures CPT 25246 documentation