Arthroplasty of the wrist with prosthetic replacement of the distal radius — resection of the distal radial segment and insertion of a synthetic implant at the wrist.

Verified May 8, 2026 · 7 sources ↓

Medicare: $869.09
Total RVUs: 26.02
Global, days: 90
Region: Wrist

Drawn from CMSAAPCEmednyCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis driving the procedure — specify whether radiocarpal arthritis, post-traumatic arthritis, avascular necrosis, or failed prior reconstruction
Extent of distal radius resection, including measurement or description of the bony segment removed
Prosthetic implant used — manufacturer, system name, and component type must appear in the operative note or implant log
Approach documented by name (e.g., dorsal, volar, or specific interval used); avoid generic 'standard approach' language
Intraoperative findings confirming the condition requiring arthroplasty rather than a lesser procedure
Laterality explicitly stated (left or right wrist) in both the operative note and on the claim

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25441 describes surgical resection of the distal radius and replacement with a prosthetic implant at the wrist joint. The procedure is performed for conditions causing structural failure of the distal radius — including severe radiocarpal arthritis, post-traumatic arthritis, or failed prior wrist reconstruction — where joint-preserving options have been exhausted. It sits within the arthroplasty family at the wrist (25441–25446), and 25441 covers the distal radius only, distinct from 25446 (total wrist replacement involving the distal radius and partial or entire carpus).

The 90-day global period means all routine postoperative care, dressing changes, and follow-up visits through day 90 are bundled into the surgical fee. Bill a same-day E/M with modifier 25 only if a separately identifiable decision was documented beyond the pre-op assessment. If the decision for this major surgery was made the day of or day before the procedure at a distinct E/M visit, append modifier 57 to that E/M code. Staged or planned subsequent wrist procedures within the global window need modifier 58; an unplanned return to the OR for a related complication takes modifier 78.

Site-of-service payment differential is material here: the HOPD rate exceeds the ASC rate by nearly $2,000 (see the Site of Service comparison table on this page). Implant cost and facility contracting often drive the site-of-service decision. Verify that your operative note specifies the prosthetic system used and the extent of bony resection — payers audit implant billing against operative documentation for high-cost wrist arthroplasty cases.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.96
Practice expense RVU	10.31
Malpractice RVU	2.75
Total RVU	26.02
Medicare national rate	$869.09
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	$869.09
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$11,157.28

Common denial reasons

The recurring reasons claims for CPT 25441 get rejected.

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

Missing or mismatched laterality modifier (LT/RT) — payer edits flag wrist arthroplasty claims without explicit side designation
Implant charges billed without corresponding operative documentation identifying the specific prosthetic system used
Bundling conflict when 25441 is billed same-day with other wrist arthroplasty codes (e.g., 25442, 25446) without NCCI modifier support and documentation of distinct structures
Global period violation — routine post-op E/M visits billed within the 90-day window without modifier 24 (unrelated) or 25 (significant separate service on day of procedure)
Medical necessity not established — insufficient documentation of failed conservative treatment or prior surgical interventions before proceeding to arthroplasty

Frequently asked questions

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

01What is the difference between CPT 25441 and 25446?

25441 covers prosthetic replacement of the distal radius only. 25446 is total wrist arthroplasty involving the distal radius and partial or the entire carpus. If you replaced both the radial and carpal components, bill 25446, not 25441.

02Do I need a laterality modifier on 25441?

Yes. Append LT or RT on every claim. Wrist arthroplasty is an inherently unilateral procedure and payers routinely reject claims without laterality designation. Modifier 50 is not appropriate here — bilateral distal radius arthroplasty in a single session is clinically rare and would require extraordinary documentation.

03Can I bill a post-op visit within the 90-day global period?

Not for routine follow-up — that's bundled. To bill an E/M within the global window, the visit must be for an unrelated condition (modifier 24) or, on the day of surgery, for a significant separately identifiable service (modifier 25). Document the distinct medical issue clearly.

04When does modifier 57 apply to 25441?

Append modifier 57 to the E/M code when the decision to perform this major surgery (90-day global) was made at an E/M visit on the day of or the day before surgery. It allows that E/M to be paid separately. Do not append 57 to the surgical code itself — it goes on the E/M.

05Can 25441 and 25442 be billed together if both the distal radius and distal ulna are replaced in the same session?

Billing both requires NCCI review and a modifier (typically 59 or XS) supported by documentation that distinct prosthetic components were placed at anatomically separate sites. Run the code pair through the CMS NCCI PTP lookup before submitting. Without a valid modifier and supporting documentation, the Column 2 code will deny.

06How does modifier 22 apply to distal radius arthroplasty?

Use modifier 22 when the procedure required substantially more work than typical — for example, severe post-traumatic deformity, prior hardware removal in the same session, or a significantly altered surgical field. Attach a cover letter quantifying the extra time and work. Payers expect documentation that clearly exceeds the standard operative effort, not just a longer case.

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 diagnosis prompting arthroplasty, the extent of distal radius resection, the named prosthetic implant system, and the surgical approach from dictation. It flags when implant documentation is absent from the note — preventing the most common audit trigger for high-cost wrist arthroplasty claims. Laterality is auto-tagged to drive correct LT/RT modifier assignment at claim generation.

See how Mira captures CPT 25441 documentation