Open arthroplasty of the wrist joint, with or without interposition material and with or without external or internal fixation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $774.90
Total RVUs: 23.2
Global, days: 90
Region: Wrist

Drawn from CMSAbosAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must name the specific arthroplasty technique performed (e.g., resectional arthroplasty, interposition arthroplasty, total wrist arthroplasty) — 'wrist revision' alone is not sufficient.
Document whether interposition material was used and, if so, the material type and source (autograft, allograft, synthetic).
Record fixation method explicitly: external fixator, internal K-wires, plate/screw construct, or no fixation — the code encompasses all, but payers may audit for consistency with implant charges.
Specify the indication and prior surgical history; if this is a revision of a previous wrist procedure, note the original surgery, date, and reason for revision.
Laterality must be documented in the operative report and match the claim modifier (LT/RT).
If modifier 22 is appended, include a separate attestation in the operative note detailing the increased time, complexity, or anatomic difficulty beyond the typical case.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 25332 covers open wrist arthroplasty — reshaping, reconstructing, or revising the wrist joint with or without interposition material and with or without fixation hardware. This is the correct code for wrist arthroplasty broadly; CPT 25447 explicitly cross-references to 25332 for wrist arthroplasty, so 25447 applied to the wrist will deny. If the procedure involves removing an existing implant and revising a prior arthroplasty, 25449 is the more specific code — confirm with the operative note whether hardware removal was the primary objective.

The 90-day global period means all routine postoperative care, dressing changes, suture removal, and follow-up visits through day 90 are bundled. Anything unrelated to the wrist arthroplasty billed in that window needs modifier 24 (E/M) or 79 (surgery). An unplanned return for a related wrist complication uses modifier 78. A staged, planned second procedure on the same wrist uses modifier 58.

Laterality matters: append LT or RT when your payer requires it. Bilateral wrist arthroplasty in one session is exceptionally rare but would use modifier 50. When a second surgeon participates as a co-primary, modifier 62 applies to both surgeons' claims; assistant surgeon services use modifier 80 or AS depending on provider type.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.45
Practice expense RVU	9.53
Malpractice RVU	2.22
Total RVU	23.2
Medicare national rate	$774.90
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	$774.90
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,101.35

Common denial reasons

The recurring reasons claims for CPT 25332 get rejected.

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

Wrong code selected: 25447 billed for wrist arthroplasty — CPT cross-reference directs wrist arthroplasty to 25332, not 25447.
Missing or mismatched laterality modifier when payer policy requires LT/RT on unilateral wrist procedures.
Global period conflict: postoperative E/M or minor procedure billed within 90 days without modifier 24 or 79, triggering automatic bundling denial.
Upcoding flag when 25332 is billed but the operative note describes a procedure more accurately captured by 25449 (revision with implant removal) or 25447 (intercarpal/carpometacarpal interposition only).
Modifier 22 denial due to absence of supporting documentation quantifying the additional work — narrative in the operative note is required, not just the modifier on the claim.

Frequently asked questions

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

01When should I use 25332 versus 25447?

Use 25332 for wrist arthroplasty. CPT 25447 is for interposition arthroplasty of intercarpal or carpometacarpal joints — it explicitly cross-references to 25332 for wrist arthroplasty. Billing 25447 for a wrist arthroplasty will deny.

02When should I use 25332 versus 25449?

25449 is for revision arthroplasty that includes removal of an existing wrist implant. If the primary goal of the procedure was revising a prior wrist arthroplasty and extracting hardware, 25449 is more specific. Review the operative note to confirm whether implant removal was a distinct, documented objective.

03Does the 90-day global period mean I can't bill anything for 90 days after surgery?

It means routine post-op care is bundled. You can still bill for unrelated E/M visits (modifier 24), unrelated procedures (modifier 79), or treatment of complications requiring a return to the OR (modifier 78 for related, 79 for unrelated). Document medical necessity clearly for anything billed in the global window.

04Is modifier 50 appropriate for bilateral wrist arthroplasty?

Yes, if both wrists are operated on in the same session. Bilateral wrist arthroplasty is rare, but modifier 50 is the correct approach. Bill one line with modifier 50; most payers reimburse at 150% of the single-procedure rate, though verify your specific payer contract.

05Do I need LT or RT on every 25332 claim?

Not universally — Medicare does not require laterality modifiers for wrist codes, but many commercial payers do. Check payer policy before submitting. The AAPC recommends appending RT or LT when payer requirements call for it, and the operative report must support whichever side you bill.

06Can I bill a same-day E/M with 25332?

Only if the E/M reflects a separately identifiable service for a condition unrelated to the wrist arthroplasty decision. Append modifier 25 to the E/M. If the visit was purely to decide on or consent for the surgery, it's bundled into the pre-op global.

07What ICD-10 codes are typically paired with 25332?

Common pairings include M19.031–M19.039 (primary osteoarthritis, wrist), M05.631–M05.639 (rheumatoid arthritis with involvement of wrist), S63 series for acute instability, and post-procedural complication codes when the arthroplasty is a revision. The diagnosis must support medical necessity for the arthroplasty specifically.

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 arthroplasty technique by name, interposition material if used, fixation method, laterality, and any documentation of increased procedural complexity directly from the surgeon's dictation. This prevents the two most common 25332 denials: code mismatch from an underdescribed operative note and modifier 22 rejections caused by missing complexity narratives.

See how Mira captures CPT 25332 documentation