Surgical · Wrist

Manipulation of the wrist joint performed while the patient is under anesthesia to restore range of motion in a stiff or restricted wrist.

Verified May 8, 2026 · 6 sources ↓

Medicare: $437.22
Total RVUs: 13.09
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specific wrist laterality (left, right, or bilateral) documented in the operative note and on the claim
Pre-procedure range-of-motion measurements demonstrating functional limitation that justifies anesthesia
Type of anesthesia used (general, regional, or monitored anesthesia care) and who administered it
Indication for manipulation under anesthesia — prior conservative treatment attempted and failed, or post-surgical contracture etiology
Post-procedure range-of-motion achieved, confirming procedural intent was met
ICD-10 diagnosis code that maps to wrist stiffness or contracture (e.g., M25.631/M25.632 for stiffness, or post-fracture/post-surgical sequela codes)

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25259 covers closed manipulation of the wrist under anesthesia — general or regional — used when conservative mobilization has failed and the joint requires forceful repositioning that the patient cannot tolerate awake. The code sits in the Introduction or Removal Procedures on the Forearm and Wrist subsection of the musculoskeletal surgery range. Common indications include post-fracture stiffness, post-surgical contracture, or wrist arthrofibrosis where passive range of motion is severely limited.

The 90-day global period is the dominant billing consideration. All routine follow-up visits, dressings, and repeat mobility assessments fall inside that window. A separate E/M during the global requires modifier 24 to indicate an unrelated problem; a new problem addressed the same day as the manipulation needs modifier 25 on the E/M before the procedure. If the patient requires a return to the OR for a related reason — say, a second manipulation because initial gains were lost — append modifier 78. For a completely unrelated wrist procedure during the 90-day global, use modifier 79.

Laterality matters. Append LT or RT to every claim — payers frequently auto-deny wrist codes lacking a side designator. Bilateral manipulation at the same session warrants modifier 50, which most commercial payers reimburse at 150% of the single-procedure rate, though Medicare applies a bilateral adjustment — verify the specific payment policy before assuming rate. The procedure is most commonly performed in an on-campus outpatient hospital or ASC setting; site-of-service payment differentials are meaningful, so confirm the appropriate place-of-service code on the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.94
Practice expense RVU	8.36
Malpractice RVU	0.79
Total RVU	13.09
Medicare national rate	$437.22
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	$437.22
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI G2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25259 get rejected.

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

Missing laterality modifier — claims without LT or RT auto-deny at many payers
Medical necessity not established — no documentation of failed conservative mobilization or objective ROM measurements
E/M billed same-day without modifier 25, triggering NCCI bundling edits
Diagnosis code mismatch — unspecified or non-wrist ICD-10 code paired with a wrist-specific surgical code
Global period conflict — follow-up visits billed without modifier 24 when another provider's global is active for the same wrist

Frequently asked questions

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

01Does CPT 25259 carry a global period, and what does that mean for follow-up billing?

Yes — 90-day global. All routine post-procedure visits, progress checks, and therapy referrals within that window are included in the procedure payment. Bill a separate E/M only for unrelated problems (modifier 24) or new problems on the same day as the manipulation (modifier 25 on the E/M).

02How do I bill if both wrists are manipulated under anesthesia in the same session?

Use modifier 50 for a bilateral procedure billed on a single line. Most commercial payers reimburse at 150% of the single-procedure rate; Medicare applies its own bilateral adjustment. Confirm your specific payer's bilateral payment policy before submitting.

03What modifier applies if the patient needs a second manipulation during the 90-day global because the first result was lost?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. The repeat manipulation is related to the original procedure, so 79 (unrelated) would be incorrect here.

04Is a separate anesthesia code billed alongside 25259?

Anesthesia is billed separately by the anesthesia provider using the applicable anesthesia CPT (typically from the 01000-series). The surgeon bills 25259 for the surgical manipulation. The surgical code itself does not include the anesthesia professional fee — that's a separate claim from a separate provider.

05Which ICD-10 codes typically support medical necessity for 25259?

Wrist joint stiffness codes M25.631 (right) and M25.632 (left) are the most direct matches. Post-fracture sequela (M84.series) and post-procedural joint disorders (M96.series) are also accepted when clinical history supports them. Avoid unspecified wrist or hand codes — they routinely trigger medical necessity reviews.

06Can 25259 be billed the same day as an E/M visit?

Yes, with modifier 25 appended to the E/M. The E/M must reflect a separately identifiable decision-making encounter — for example, an evaluation confirming the patient meets criteria for manipulation under anesthesia that same day. Document it as distinct from the pre-procedure assessment that is already bundled into the surgical package.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures wrist laterality, the specific anesthesia type, pre- and post-manipulation range-of-motion values, and the clinical rationale (e.g., post-fracture contracture, failed conservative mobilization) directly from the surgeon's dictation. That locked documentation prevents the two most common denials for 25259: missing side designator and unsupported medical necessity.

See how Mira captures CPT 25259 documentation