Surgical repair of a scaphoid nonunion, with or without radial styloidectomy; includes harvesting and placing a bone graft and applying necessary fixation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $704.76
Total RVUs: 21.1
Global, days: 90
Region: Wrist

Drawn from CMSAAPCCgsmedicarePayerpriceEmedny

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 scaphoid nonunion confirmed by imaging (X-ray, CT, or MRI), with dates and findings documented in the preoperative workup
Operative note must name the surgical approach (dorsal, volar, or combined) — generic 'standard approach' language triggers audit flags
Graft source documented explicitly (e.g., distal radius, iliac crest) along with harvest technique and graft dimensions
Fixation type and configuration documented (e.g., headless compression screw size and placement angle)
Whether radial styloidectomy was performed must be stated; absence of documentation means the payer cannot confirm the full scope of work
Laterality (left or right wrist) clearly noted in the operative report and on the claim
Duration of prior nonunion and prior treatment attempts, supporting medical necessity for surgical intervention

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25440 covers open repair of a scaphoid (navicular) carpal bone that has failed to unite after fracture. The procedure involves excising fibrous tissue at the nonunion site, harvesting a bone graft (typically from the distal radius or iliac crest), placing the graft at the defect, and securing fixation — usually a headless compression screw or K-wires. Radial styloidectomy is included in the code when performed and does not warrant a separate charge.

The 90-day global period governs all post-op care: routine wound checks, cast or splint changes, hardware surveillance imaging ordered as part of standard fracture management, and suture removal are all bundled through day 90. Unrelated conditions managed during that window require modifier 24 on the E/M; a staged or unrelated surgical return needs modifier 79. A return to the OR for a complication directly tied to the scaphoid repair — hardware failure, wound dehiscence, graft site issues — bills under modifier 78.

Graft harvest from a remote site (e.g., iliac crest) is included in 25440 per the code descriptor. Do not separately bill a graft-harvest code. Fixation hardware (screws, pins) is similarly bundled. When fluoroscopic guidance is used intraoperatively, it is integral and not separately reportable per NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.41
Practice expense RVU	8.69
Malpractice RVU	2
Total RVU	21.1
Medicare national rate	$704.76
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	$704.76
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 25440 get rejected.

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

Lack of imaging documentation confirming nonunion prior to surgery — payers require objective evidence of failed healing, not just clinical suspicion
Separate billing of bone graft harvest (e.g., 20900, 20902) alongside 25440 — graft procurement is bundled into the code descriptor and will deny
Missing or ambiguous laterality on the claim — LT/RT modifier absent causes payer-side edit failures, especially for Medicare and large commercial plans
Billing intraoperative fluoroscopy separately — NCCI bundles radiologic guidance into the surgical procedure when used to guide fixation
Post-op E/M claims within the 90-day global period submitted without modifier 24 or 25, resulting in automatic denial

Frequently asked questions

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

01Can I bill separately for the bone graft harvest with CPT 25440?

No. The 25440 descriptor explicitly includes obtaining the graft. Separately billing a harvest code (e.g., 20900 or 20902) alongside 25440 will be denied under NCCI bundling rules regardless of site.

02If I perform a radial styloidectomy during the same session, does that get a separate code?

No. Radial styloidectomy is bundled into 25440 per the code descriptor ('with or without radial styloidectomy'). Billing it separately triggers an NCCI edit.

03What modifier applies if the patient returns to the OR within 90 days because the fixation hardware backed out?

Modifier 78 — unplanned return to the OR for a complication directly related to the original scaphoid repair. Hardware failure and wound complications from the index procedure are related. Modifier 79 applies only to a genuinely unrelated procedure in the global window.

04Is 25440 appropriate for a scaphoid malunion (healed but in poor position), or only nonunion?

The code specifically addresses nonunion. For malunion without frank nonunion, coders have debated 25440 versus 25999 (unlisted). Document the pathology precisely — if the operative note describes nonunion tissue requiring excision and grafting, 25440 is defensible; for pure malunion osteotomy without a graft, 25999 with a crosswalk narrative is the safer route.

05How should I handle laterality for bilateral scaphoid nonunion repair (rare but possible)?

Bill two lines with LT and RT modifiers. In an ASC, report each line separately with LT and RT per NCCI ASC billing rules. For a physician claim, modifier 50 on a single line is acceptable, but confirm the payer's preference — some Medicare contractors prefer the two-line format even for Part B.

06Can a PA or NP assist and bill separately under modifier AS?

Yes, when a non-physician practitioner assists rather than a second surgeon. Bill the assistant's claim with modifier AS. If a second physician co-surgeon is medically necessary, modifier 62 applies to both surgeons' claims, with documentation explaining why two surgeons were required.

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 approach by name, graft source and dimensions, fixation hardware type and size, whether radial styloidectomy was performed, and intraoperative imaging use — all from surgeon dictation. That detail prevents the two most common audit flags on 25440: an operative note that omits the approach name, and ambiguity about whether graft harvest was remote or local (which determines whether a separate harvest code is even arguable).

See how Mira captures CPT 25440 documentation