Secondary soft tissue reconstruction to stabilize an unstable distal ulna or distal radioulnar joint (DRUJ), using tendon transfer, graft, weave, or tenodesis, with or without open reduction of the DRUJ.

Verified May 8, 2026 · 7 sources ↓

Medicare: $828.34
Total RVUs: 24.8
Global, days: 90
Region: Wrist

Drawn from CMSAAPCEmednyCgsmedicareEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify that this is a secondary reconstruction, not a primary repair — note prior treatment history or failed prior stabilization
Name the exact soft tissue technique used: tendon transfer, tendon graft, weave, or tenodesis
Document whether open reduction of the distal radioulnar joint was performed and if so, its findings and outcome
Identify graft source and harvest site if autograft was used, including a separate description of graft harvest if billed separately
Record preoperative instability findings (clinical exam, imaging) confirming DRUJ instability requiring secondary reconstruction
Note laterality (left or right wrist) explicitly in the operative report

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side 24 Unrelated E/M during global 25 Significant separate E/M 78 Unplanned return — related

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25337 describes a secondary (not primary) reconstruction procedure at the distal radioulnar joint. The surgeon stabilizes the DRUJ through soft tissue techniques — tendon transfer, tendon graft or weave, or tenodesis — and may include open reduction of the joint. The 'secondary' designation is clinically and codologically significant: this code is for cases where primary repair has failed or was not performed, not for initial ligament repair at the time of acute injury.

The 90-day global period covers the surgery, the day-before visit, and all routine postoperative management through day 90. Any E/M service during that window for a reason unrelated to DRUJ reconstruction requires modifier 24. A same-day E/M that is significant and separately identifiable from the surgical decision requires modifier 25.

Common confusion involves 25320 (primary capsulorrhaphy/reconstruction of the wrist for carpal instability) and 25332 (wrist arthroplasty). 25337 is specifically for secondary DRUJ soft tissue stabilization. Billing 25337 when the operative note describes a primary repair, or substituting it for 25332 after an authorization listed that code, are both audit and denial risks.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.44
Practice expense RVU	11.17
Malpractice RVU	2.19
Total RVU	24.8
Medicare national rate	$828.34
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	$828.34
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25337 get rejected.

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

Authorization listed 25332 or 25320 but claim billed 25337 — payer treats this as a non-authorized code
Operative note describes a primary repair or acute ligament fixation rather than a secondary reconstruction, mismatching the 25337 descriptor
Missing laterality modifier (LT or RT) triggers claim suspension or system rejection for unilateral procedures
Global period conflict when a routine postoperative visit is billed within 90 days without modifier 24 to indicate an unrelated diagnosis
Bundling denial when tendon graft harvest is billed separately without documentation supporting a distinct, separately reportable service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What makes 25337 a 'secondary' reconstruction — and why does that matter for coding?

25337 is reserved for cases where primary repair was not done at the time of injury or has failed. If the surgeon is performing initial DRUJ ligament repair acutely, 25337 is not the right code. Payer reviewers and auditors look for documentation of prior treatment failure or delayed presentation to support the secondary designation.

02Can 25337 and 25320 be billed together on the same date?

Only if distinct anatomic work supports separate reporting — 25320 addresses carpal instability via capsulorrhaphy or ligament repair, while 25337 addresses DRUJ soft tissue stabilization. If both procedures are genuinely performed at separate anatomic sites, append modifier 59 to the column-2 code and document each procedure distinctly in the operative note. Bundling edits may apply; verify via the NCCI PTP lookup before submitting.

03Does 25337 require a laterality modifier?

Yes. Append LT or RT to identify the operative side. For a physician claim, a bilateral procedure is reported on a single line with modifier 50. For ASC facility claims, report two lines using LT and RT separately per CMS NCCI Chapter 4 guidance.

04If an assistant surgeon scrubs in, how is that billed?

A physician assistant surgeon bills with modifier 80. If a PA, NP, or CNS assists, use modifier AS. If two co-primary surgeons each perform distinct components, both bill 25337 with modifier 62. Document each surgeon's distinct work in separate operative notes or a co-surgeon attestation.

05What ICD-10 diagnoses are typically linked to 25337?

DRUJ instability (M25.331/M25.332 for wrist instability by laterality) and sequelae of prior wrist injury or ligament disruption are the most common supporting diagnoses. The ICD-10 code must reflect instability or a condition requiring secondary reconstruction — an acute sprain code alone will not support this procedure.

06Is an E/M on the same day as 25337 separately billable?

Only if it is significant, separately identifiable, and not the visit that led to the surgical decision. Append modifier 25 to the E/M. The decision to perform surgery itself is bundled into the global; modifier 57 applies when the decision for a major procedure is made the day before or day of surgery.

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 secondary nature of the reconstruction, the specific soft tissue stabilization technique (transfer, graft, weave, or tenodesis), whether open reduction of the DRUJ was performed, graft source if applicable, and explicit laterality from the surgeon's dictation. This prevents the most common 25337 denial: an operative note that omits the 'secondary' context or fails to name the technique, giving payer reviewers grounds to downcode or reject the claim as insufficiently documented.

See how Mira captures CPT 25337 documentation