Insertion of a vascular pedicle into a carpal bone to restore blood supply to avascular or necrotic wrist bone tissue (e.g., Hori procedure).

Verified May 8, 2026 · 8 sources ↓

Medicare: $695.41
Total RVUs: 20.82
Global, days: 90
Region: Wrist

Drawn from CMSAAPCBeonbrandCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Diagnosis of avascular necrosis of the specific carpal bone (e.g., lunate, scaphoid) with ICD-10 code documented in the operative and clinic notes.
Operative note must identify the procedure by name (e.g., Hori procedure or vascular pedicle insertion) — 'bone graft' alone is insufficient.
Document the donor site and harvesting technique, including which vessel or vascular pedicle was used and its origin (e.g., distal radius periosteal pedicle).
Specify the recipient carpal bone by name; audit teams flag notes that say only 'affected carpal bone' without identifying the specific bone.
Document fixation method used to stabilize the pedicle graft (screws, K-wires, or other hardware) and post-op immobilization plan.
Pre-operative imaging (MRI or X-ray) confirming avascular necrosis stage and justifying surgical intervention over conservative management.

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 25430 covers surgical implantation of a vascular pedicle — a segment of bone with its attached blood vessels, typically harvested from the distal radius — into a carpal bone suffering from avascular necrosis. The lunate (Kienböck disease) and scaphoid are the most common targets. The goal is revascularization: re-establishing arterial inflow to dead or dying bone to halt deterioration, promote healing, and preserve wrist function before collapse becomes irreversible.

The procedure carries a 90-day global period. All routine post-op visits, dressing changes, cast checks, and immobilization management through day 90 are bundled. Unrelated problems billed in that window require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25. When 25430 is billed alongside wrist arthroplasty codes such as 25446 or revision code 25449, NCCI bundles 25430 as the component — the comprehensive arthroplasty code takes Column 1 priority and 25430 will deny without a clinically supported modifier.

Distinguish 25430 from adjacent codes before you bill: 25440 (scaphoid nonunion repair) explicitly includes graft harvest, so stacking 25430 with 25440 for a scaphoid case will trigger a bundling denial. 25431 covers nonunion repair of non-scaphoid carpal bones. Use 25430 specifically when the operative note documents vascular pedicle insertion as the primary intervention — not a standard bone graft — and the indication is avascular necrosis rather than nonunion with structural defect.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.47
Practice expense RVU	9.33
Malpractice RVU	2.02
Total RVU	20.82
Medicare national rate	$695.41
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	$695.41
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 25430 get rejected.

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

Bundling denial when billed with 25440 (scaphoid nonunion repair) — graft harvest is already included in 25440 and 25430 is not separately payable.
Bundling denial when billed as a component of wrist arthroplasty codes 25446 or 25449 without a clinically supported NCCI-associated modifier.
Operative note describes a standard bone graft rather than a vascularized pedicle with intact blood supply — payer downcodes or denies for insufficient documentation of the vascular component.
Missing or non-specific diagnosis — payer requires documented avascular necrosis with staging; 'wrist pain' or 'carpal injury' does not support 25430.
Incorrect laterality billing — LT/RT modifier absent when payer requires it, or bilateral billing (modifier 50) without documented bilateral avascular necrosis.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can I bill 25430 and 25440 together for a scaphoid case?

No. CPT 25440 (scaphoid nonunion repair) explicitly includes obtaining the graft. Billing 25430 alongside 25440 for the same bone on the same date will trigger a bundling denial. Use 25440 alone when the scaphoid is the target and nonunion is the primary indication.

02What is the global period for 25430 and what does it cover?

25430 carries a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op care through day 90 — including cast changes, suture removal, and immobilization checks. Bill unrelated problems in the global window with modifier 24 on the E/M.

03How does 25430 differ from a standard bone graft code?

25430 is specifically for insertion of a vascularized pedicle — bone harvested with its attached blood vessels to restore arterial inflow to a necrotic carpal bone. A conventional bone graft (avascular) does not support 25430. The operative note must document the vascular attachment explicitly.

04Does NCCI bundle 25430 with wrist arthroplasty codes?

Yes. NCCI edits bundle 25430 as a component when billed with comprehensive codes including 25446 (total wrist arthroplasty) and 25449 (arthroplasty revision). The arthroplasty code is Column 1. To bill both, you need a clinically appropriate modifier and documentation supporting distinct, separately identifiable procedures.

05Which carpal bones is 25430 most commonly used for?

The lunate (Kienböck disease) and scaphoid are the most common targets for vascular pedicle insertion. Confirm the specific bone in the operative note — payers and audit teams expect bone-level specificity, not just 'carpal bone.'

06Is modifier 50 appropriate if bilateral carpal bones are treated?

Bilateral avascular necrosis of carpal bones is rare, but if both wrists are treated at the same operative session and documented as medically necessary, modifier 50 applies. Most payers require individual line billing with LT and RT in lieu of modifier 50 — verify payer preference before submitting.

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 targeted (e.g., lunate, scaphoid), the vascular pedicle donor site and vessel identified intraoperatively, fixation method, and the laterality of the procedure from surgeon dictation. This prevents the most common audit flag: an operative note that documents 'bone graft' without confirming the vascular pedicle harvest and intact blood supply — the distinction that separates 25430 from non-billable bundled components of adjacent codes.

See how Mira captures CPT 25430 documentation