Surgical procedure that repositions the hand over the ulna to correct severe radial deviation, most commonly performed for congenital radial club hand (absent or hypoplastic radius).
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $874.77
- Total RVUs
- 26.19
- 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 6 cited references ↓
- Diagnosis of radial dysplasia or radial club hand with ICD-10 code specified (e.g., Q71.4)
- Operative note documenting degree of radial deviation present and corrected during the procedure
- Description of fixation method used (e.g., K-wire size, number, and placement)
- Documentation of any concurrent soft tissue procedures such as tendon lengthening or capsular release
- Laterality clearly stated — left, right, or bilateral — to support modifier assignment
- Pre-operative imaging (X-ray) confirming structural deficiency of the radius
- Prior authorization documentation attached to the claim where required by the payer
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 6 cited references ↓
CPT 25335 describes centralization of the wrist on the ulna — a reconstructive procedure that repositions the carpus directly over the distal ulna to correct the radial deviation caused by radial dysplasia or radial club hand. The radius is absent or severely underdeveloped in these patients, leaving the hand angulated radially without a bony buttress. The surgeon realigns the carpus, balances soft tissue tension, and stabilizes the construct, typically with K-wire fixation.
This is a low-volume, high-complexity pediatric hand procedure. It carries a 90-day global period, meaning all routine follow-up visits, splint changes, and pin removals within 90 days are bundled. Any unrelated E&M or procedure in that window requires modifier 24 or 79, respectively. Because bilateral radial club hand occurs in a meaningful subset of patients, modifier 50 is relevant when both sides are addressed in the same session.
Prior authorization is nearly universal for this code given its congenital indication and pediatric population. ICD-10 Q71.4 (longitudinal reduction defect of radius) is the primary diagnosis driver. Operative notes must document the degree of radial deviation corrected, fixation method, and any concurrent soft tissue procedures — failure to do so is the leading cause of downcoding or medical necessity denials.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.06 |
| Practice expense RVU | 10.36 |
| Malpractice RVU | 2.77 |
| Total RVU | 26.19 |
| Medicare national rate | $874.77 |
| 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 | $874.77 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 25335 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or insufficient prior authorization for a congenital reconstructive procedure
- ICD-10 diagnosis code does not establish medical necessity for ulnar centralization (wrong or nonspecific code)
- Operative note lacks detail on fixation method or degree of deformity corrected, triggering downcoding
- Bilateral procedure billed without modifier 50, causing the second-side claim to deny as duplicate
- Services billed during the 90-day global period without required modifier 24 or 79
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the global period for CPT 25335?
02Which ICD-10 code pairs with 25335 for radial club hand?
03Can 25335 be billed bilaterally?
04When is modifier 22 appropriate for CPT 25335?
05Is prior authorization required for CPT 25335?
06How does the site of service affect reimbursement for 25335?
07Can concurrent soft tissue procedures be billed separately with 25335?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/25335
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/25335
- 04vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/25335/info
- 05cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 06findacode.comhttps://www.findacode.com/cpt/25335-cpt-code.html
Mira AI Scribe
Mira's AI scribe captures the degree of radial deviation corrected, fixation details (K-wire gauge and count), laterality, and any concurrent soft tissue work directly from the surgeon's dictation. This prevents the operative note vagueness — 'wrist centralization performed' — that auditors flag as insufficient to support medical necessity and that payers use to justify downcoding or denial.
See how Mira captures CPT 25335 documentation