Surgical removal of a previously implanted wrist joint prosthesis, performed as a standalone procedure.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $513.71
- Work RVU
- 6.6
- 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 5 cited references ↓
- Operative note must name the specific prosthesis removed (manufacturer, model if available) and laterality (left vs. right wrist).
- Document the indication for removal: device failure, infection, aseptic loosening, or adverse reaction — not just 'prosthesis removal.'
- Record intraoperative findings including degree of scar tissue, bone loss, cement or fixation hardware encountered, and condition of surrounding soft tissue.
- If modifier 22 is appended for increased complexity, include a separate statement quantifying the additional work and time beyond typical removal.
- Specify whether the wound was closed primarily, packed open, or a spacer was placed — relevant to staging and subsequent billing.
- Pre-op imaging or culture results supporting the indication should be referenced or included in the medical record.
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 5 cited references ↓
CPT 25250 covers the operative removal of an artificial wrist joint that was placed in a prior surgery. The indication is almost always one of three things: device failure, periprosthetic infection, or an adverse biological reaction to implant materials. Because the implant has been in place — often for years — surgeons routinely encounter scar tissue, bony ingrowth, and cement or fixation hardware that must be carefully addressed before the prosthesis can be extracted. That added complexity is what separates this from a routine implant exchange and drives its 90-day global period.
The 90-day global covers the day-before visit, the surgery itself, and all routine post-op care through day 90. Anything unrelated to the wrist prosthesis removal billed inside that window needs modifier 24 (E/M) or modifier 79 (unrelated operative return). If the surgeon plans a staged reimplantation — for example, after infectious clearance — that second procedure is billed with modifier 58.
This code sits under the Introduction or Removal Procedures on the Forearm and Wrist section of the CPT code set. It is designated a 'separate procedure,' meaning NCCI edits will bundle it when it's performed as an incidental part of a more extensive wrist surgery. Bill it alone or justify its distinct nature with modifier 59 when it accompanies a clearly different, unrelated procedure at the same operative session.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (6.6) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 6.6 |
| Practice expense RVU | 7.38 |
| Malpractice RVU | 1.4 |
| Total RVU | 15.38 |
| Medicare national rate | $513.71 |
| 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 | $513.71 |
HOPD (APC 5112) Hospital outpatient department | $1,642.82 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $872.87 |
Common denial reasons
The recurring reasons claims for CPT 25250 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundling denial when 25250 is billed alongside a more comprehensive wrist procedure without modifier 59 to establish it as a distinct service.
- Missing or mismatched laterality — payers require LT or RT on facility claims; absent modifier triggers automatic rejection at many MACs.
- Modifier 58 missing when a staged reimplantation is billed inside the 90-day global of the original implant procedure.
- Insufficient documentation of medical necessity — operative notes that list only 'prosthesis removal' without a coded indication (e.g., T84.53XA for infection, T84.03XA for mechanical loosening) are routinely flagged.
- Incorrect use of modifier 78 instead of 58 for a planned staged return — 78 is for unplanned, related returns; using it on a scheduled reimplantation inverts the intent and triggers audit flags.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Is 25250 always a separate procedure, and does that limit when I can bill it?
02Which modifier applies when I remove the prosthesis now and plan to reimplant in 6–8 weeks after infection clearance?
03Do I need both LT/RT and modifier 50 if I'm removing bilateral wrist prostheses in one session?
04What ICD-10 codes pair cleanly with 25250 for medical necessity?
05Can modifier 22 be used if the removal was significantly harder than typical due to extensive bone loss or cement fixation?
06Does the 90-day global on 25250 affect billing for post-op physical therapy or DME?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira Scribe
Mira's AI scribe captures the prosthesis type and laterality from dictation, the documented indication (infection, loosening, material reaction), and key intraoperative findings — scar burden, bone loss, hardware encountered. That prevents the two most common denials: a missing laterality modifier and a vague operative note that can't support medical necessity on audit.
See how Mira captures CPT 25250 documentation