Arthroplasty of the wrist with prosthetic replacement of the distal ulna.

Verified May 8, 2026 · 4 sources ↓

Medicare: $740.50
Total RVUs: 22.17
Global, days: 90
Region: Wrist

Drawn from CMSEmedny

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Operative report must identify the specific implant manufacturer, model, and size placed at the distal ulna
Document the indication by name — rheumatoid arthritis, post-traumatic arthritis, failed prior resection, etc.
Describe the surgical approach and confirm distal ulna resection with prosthetic implantation, not simple resection alone (25240)
Document which wrist was operated on (left or right) to support LT/RT modifier if billed separately or bilaterally
Pre-op imaging (X-ray or CT) confirming distal radioulnar joint pathology should be in the chart
Dictate implant lot and serial numbers for implant registry and audit traceability

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 50 Bilateral procedure 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 AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 25442 covers surgical arthroplasty at the wrist involving resection of the distal ulna and implantation of a prosthetic replacement. This is a distinct procedure from distal radius replacement (25441) and total wrist arthroplasty (25446) — code selection must reflect exactly which bone received the implant. Common indications include rheumatoid arthritis with distal radioulnar joint destruction, post-traumatic arthritis, and failed prior distal ulna resection (Darrach or Sauvé-Kapandji).

The 90-day global period means the surgery, the day-before visit, and all routine post-op management through day 90 are bundled. Separately bill any service unrelated to the wrist arthroplasty during that window with modifier 24 (E/M) or 79 (unrelated procedure). If a complication requires an unplanned return to the OR for a related procedure within the global, use modifier 78 — not 79.

Site of service matters here: the HOPD and ASC payment rates differ meaningfully. When billing bilateral procedures (uncommon but possible in rheumatoid disease), append modifier 50 or use separate line items with LT/RT. If a second surgeon scrubs in as a co-surgeon, append modifier 62; for assistant surgeons, use modifier 80 or AS for non-physician practitioners.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.84
Practice expense RVU	9.28
Malpractice RVU	2.05
Total RVU	22.17
Medicare national rate	$740.50
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	$740.50
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$14,178.74

Common denial reasons

The recurring reasons claims for CPT 25442 get rejected.

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

Wrong code selected: distal radius replacement (25441) or total wrist (25446) used when only the distal ulna was replaced
Unbundling: separately billing simple distal ulna resection (25240) alongside 25442 for the same wrist
Missing laterality modifier when payer policy requires LT or RT on wrist procedure claims
Global period violations: billing routine post-op E/M visits without modifier 24 during the 90-day window
Implant not documented in operative note, triggering medical necessity or documentation-based denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01What's the difference between 25442 and 25240?

25240 is simple resection of the distal ulna (Darrach procedure) with no implant. 25442 requires prosthetic replacement of the resected distal ulna. If you resect and implant, bill 25442. Billing both for the same wrist is unbundling.

02Can 25442 and 25441 be billed together for the same wrist?

Only if both the distal radius and distal ulna each received a separate prosthetic implant and the operative report documents both replacements distinctly. If the plan was a total wrist replacement, 25446 is the correct single code. Use modifier 59 or XS only when genuinely distinct implants were placed at separate anatomic structures.

03How do I bill a same-day E/M with 25442?

A same-day E/M requires modifier 57 if it represents the decision for surgery, or modifier 25 is not applicable here since 25442 has a 90-day global. Modifier 57 applies when the E/M on the day of or day before surgery drives the decision to operate.

04Is an assistant surgeon payable on 25442?

Check the CMS assistant surgeon indicator for 25442 on the Physician Fee Schedule lookup. If payable, bill with modifier 80 for an MD/DO assistant or modifier AS for a PA or NP assistant. Some payers require documentation that an assistant was medically necessary.

05What modifier applies if the patient returns to the OR within 90 days for loosening of the ulnar implant?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Modifier 79 is for unrelated procedures only. Inverting these is a common audit finding.

06Does the 90-day global include physical therapy referrals?

No. PT services billed under the therapist's or facility's NPI are outside the surgical global and are separately reimbursable. What the global bundles is the operating surgeon's own post-op management, not ancillary rehabilitation services.

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 implant used (name, manufacturer, size), the indication driving surgery, the surgical approach, and explicit confirmation that the distal ulna — not the radius or total wrist — received the prosthetic replacement. That distinction prevents the most common code-selection errors (25441 vs. 25442 vs. 25446) and gives auditors the operative detail needed to defend the claim.

See how Mira captures CPT 25442 documentation