Open capsulorrhaphy or ligamentous reconstruction of the wrist, addressing instability through repair or reconstruction of carpal ligaments and joint capsule.

Verified May 8, 2026 · 5 sources ↓

Medicare: $927.54
Total RVUs: 27.77
Global, days: 90
Region: Wrist

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specific ligaments or capsular structures repaired or reconstructed (e.g., scapholunate interosseous ligament, dorsal capsule) — 'ligament repair' alone is insufficient
Pre-operative diagnosis supported by imaging (MRI, arthroscopy, or stress radiographs) confirming instability pattern
Operative note documenting open approach, joint visualization, and technique used (imbrication, direct repair, tendon graft reconstruction)
Documentation of failed conservative management or acute/chronic injury severity justifying surgical intervention
If modifier 22 appended: explicit notation of factors increasing complexity — prior surgery, scar tissue, graft harvest, multi-ligament involvement — with estimated additional time
Laterality clearly stated in both the operative note and on the claim

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25320 covers open surgical repair or reconstruction of the wrist joint capsule and carpal ligaments — performed for conditions such as scapholunate dissociation, lunotriquetral instability, DRUJ instability, or chronic carpal ligament tears that have failed conservative management. The procedure involves direct visualization of the wrist joint, with capsular imbrication, ligament repair, or reconstruction using local tissue or graft depending on the acuity and severity of instability.

This is a 90-day global code. All routine post-op visits, dressing changes, and cast checks through day 90 are included. A decision-for-surgery E/M on the day before or day of surgery requires modifier 57. Any unrelated E/M during the global window requires modifier 24. If the patient returns to the OR during the global period for a related complication, use modifier 78 — not 79.

Bilateral wrist reconstruction on the same day is rare but possible; use modifier 50 or LT/RT as your payer requires. If the complexity of reconstruction — such as extensive scarring, prior failed repair, or multi-ligament involvement — substantially increases operative time and work, modifier 22 is appropriate with supporting documentation. Modifier 22 claims without an operative note detailing the specific factors will be denied.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.43
Practice expense RVU	12.93
Malpractice RVU	2.41
Total RVU	27.77
Medicare national rate	$927.54
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	$927.54
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25320 get rejected.

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

Operative note lacks specificity on which ligaments or capsular structures were addressed — 'wrist stabilization procedure' without anatomic detail triggers audit flags
Missing pre-operative imaging or arthroscopic findings to support the instability diagnosis billed
Modifier 22 submitted without documentation quantifying the increased complexity or additional operative time
E/M billed same day without modifier 25 (if pre-op evaluation) or modifier 57 (if decision for surgery made that day for this 90-day global procedure)
Unbundling errors: separately billing associated tendon transfers or bone grafts when those components are integral to the reconstruction at the same site

Frequently asked questions

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

01Can 25320 be billed with wrist arthroscopy (29840–29847) on the same day?

If arthroscopy is performed diagnostically and then converted to an open procedure, only the open code is billed. If arthroscopy is performed at a distinct session or for a separate indication, modifier 59 or XS may apply — but expect payer scrutiny and confirm NCCI edits before submitting. Document the distinct clinical necessity for each.

02What modifier applies if the patient returns to the OR within the 90-day global for a wound complication?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 (that's for an unrelated procedure in the global period). Modifier 78 reimburses at the intraoperative component only, not the full global fee.

03Is a pre-operative E/M on the day of surgery separately billable?

Yes, if the decision for surgery was made at that visit. Append modifier 57 to the E/M because 25320 carries a 90-day global. Without modifier 57, the E/M will deny as included in the global pre-op period.

04When is modifier 22 justified for 25320?

When the operative work is substantially greater than typical — for example, a revision after failed prior reconstruction, multi-ligament instability requiring graft harvest, or a field complicated by prior hardware or scarring. The operative note must explicitly describe the complicating factors and document the increased time. A generic statement that 'the case was difficult' won't hold up in audit.

05Can 25320 be billed with a bone graft code if graft is used for reconstruction?

It depends on the graft source and technique. Autograft harvest from a separate site may be separately reportable; local tissue graft typically is not. Check NCCI edits for the specific graft code pairing and document graft harvest as a distinct procedure if billing separately.

06What is the global period for 25320 and what does it include?

25320 carries a 90-day global period. It covers the day-before visit, the surgery itself, and all routine post-operative care through day 90 — including cast checks, suture removal, and wound care. Services unrelated to the wrist reconstruction billed during this window need modifier 24 on the E/M.

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 ligaments and capsular structures addressed, the surgical approach, whether graft was used (and harvest site), and any factors increasing complexity such as prior failed repair or extensive scarring. This prevents the most common audit flag for 25320: an operative note that describes a wrist stabilization generically without naming the anatomic structures repaired — which payers treat as insufficient to support the code.

See how Mira captures CPT 25320 documentation