Surgical shortening of a carpal bone by removing a segment of bone to correct length discrepancy at the wrist.

Verified May 8, 2026 · 7 sources ↓

Medicare: $735.49
Total RVUs: 22.02
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific carpal bone operated on (e.g., lunate, capitate, hamate) by name in the operative note
Document the surgical indication — ulnar impaction, carpal height discrepancy, post-traumatic deformity — with pre-op imaging correlation
Describe the measured amount of bone resected and the fixation method used (plate, screws, K-wires)
Record intraoperative fluoroscopy use as inherent to the procedure, not as a separately billable service
Note any concomitant procedures with distinct anatomic sites if modifier 59 or XS is appended
For modifier 22 claims, include explicit documentation of added time, complexity, or anatomic difficulty beyond typical cases

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 59 Distinct service 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25394 covers operative shortening of a carpal bone — the surgeon resects a bone segment to reduce carpal length, typically addressing ulnar impaction syndrome or carpal height imbalance. The procedure involves osteotomy, removal of the calculated bone segment, and internal fixation to restore wrist mechanics. It carries a 90-day global period, meaning all routine post-op care, cast changes, and wound checks through day 90 are bundled with no separate billing.

Hand surgeons perform this procedure most frequently. Fluoroscopy used intraoperatively is integral to the procedure and not separately reportable. If a significant additional procedure is performed at a distinct anatomic site the same day, modifier 59 or an X-modifier documents separate anatomic site per NCCI PTP rules — but contiguous wrist structures don't qualify as distinct sites.

For bilateral cases (rare), modifier 50 applies. If complexity significantly exceeds the typical procedure — unusually severe deformity, revision after prior failed osteotomy, extensive reconstruction — document the added work thoroughly and append modifier 22 with a supporting cover letter quantifying extra time and complexity.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.58
Practice expense RVU	9.19
Malpractice RVU	2.25
Total RVU	22.02
Medicare national rate	$735.49
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	$735.49
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25394 get rejected.

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

Operative note lacks identification of the specific carpal bone, triggering medical necessity review
Fluoroscopy billed separately as an add-on, creating an NCCI PTP bundling denial
Modifier 22 appended without a supporting narrative quantifying extra work, causing payer rejection
Concomitant wrist procedure billed with modifier 59 when performed on a contiguous structure rather than a distinct anatomic site
Missing pre-operative imaging documentation to establish indication, prompting medical necessity denial

Frequently asked questions

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

01What does the 90-day global period include for 25394?

All routine post-operative visits, cast or splint changes, wound checks, and suture removal through day 90 are bundled. Bill unrelated E/M services in that window with modifier 24; bill related staged procedures with modifier 78 or 79 depending on whether they are related or unrelated to the original procedure.

02Can fluoroscopy be billed separately with 25394?

No. Intraoperative fluoroscopy is integral to the osteotomy and not separately reportable per CMS NCCI policy. Attempting to bill a fluoroscopy code alongside 25394 will result in a bundling denial with no modifier override available.

03When does modifier 22 apply to 25394?

Append modifier 22 when the procedure is substantially more complex than typical — for example, revision after prior failed osteotomy, severe post-traumatic deformity, or prolonged operative time. You must attach a written justification to the claim quantifying the extra work; payers routinely deny modifier 22 claims submitted without a supporting narrative.

04Is 25394 ever billed bilaterally?

Bilateral carpal shortening is rare but possible. If performed on both wrists at the same session, append modifier 50. Some payers require LT and RT on separate lines instead — verify payer preference before submitting.

05How does NCCI modifier indicator affect same-day wrist procedures?

NCCI PTP edits bundle procedures performed on contiguous wrist structures. Modifier 59 or XS can bypass edits only when the second procedure is performed at a genuinely distinct anatomic site. Different diagnoses alone do not justify modifier use — the anatomic sites must be separate per CMS NCCI policy.

06What ICD-10 diagnoses typically support 25394?

Ulnar impaction syndrome, post-traumatic carpal collapse, and carpal height discrepancy secondary to avascular necrosis are the most common supporting diagnoses. The diagnosis must be correlated with pre-operative imaging cited in the operative or office note to satisfy medical necessity review.

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 carpal bone operated on, the surgical indication, the measured segment of bone removed, the fixation construct, and fluoroscopy use from dictation. That prevents the two most common audit flags: a generic 'carpal osteotomy' operative note that omits bone identification, and a separately billed fluoroscopy line that NCCI bundles without modifier relief.

See how Mira captures CPT 25394 documentation