Arthroplasty with prosthetic replacement of the distal scaphoid at the carpus — insertion of an implant to replace the scaphoid bone at the wrist joint.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $737.49
- Total RVUs
- 22.08
- Global, days
- 90
- Region
- Wrist
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Preoperative imaging (X-ray, CT, or MRI) confirming scaphoid pathology requiring prosthetic replacement
- Operative note naming the prosthetic implant, size, and fixation method used
- Documentation of prior treatment history (conservative care, prior fixation attempts) supporting medical necessity of arthroplasty over fusion or excision
- Specific surgical approach documented by name — do not write 'standard approach'
- Postoperative diagnosis confirming scaphoid nonunion, AVN, or advanced carpal collapse
- Laterality clearly noted (left vs. 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
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 25443 covers surgical placement of a prosthetic implant at the distal scaphoid-carpal articulation. It is most commonly performed for failed scaphoid fracture healing (scaphoid nonunion), avascular necrosis of the scaphoid, or advanced carpal instability where the native scaphoid can no longer be salvaged. The surgeon resects the compromised scaphoid and seats a prosthetic replacement to restore carpal height and kinematics.
This is a 90-day global procedure. All routine follow-up through day 90 — including dressing changes, cast or splint management, and standard post-op visits — is bundled. Bill any unrelated E/M or procedure in the global window with modifier 24 or 79, respectively. A staged or planned secondary wrist procedure after this surgery requires modifier 58.
Documentation must support the medical necessity of prosthetic replacement over fusion or simple excision. Preoperative imaging, prior treatment history, and the operative note identifying implant type, size, and fixation method are all audit targets. Payers increasingly scrutinize scaphoid arthroplasty claims where conservative treatment history is absent from the record.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.39 |
| Practice expense RVU | 9.49 |
| Malpractice RVU | 2.2 |
| Total RVU | 22.08 |
| Medicare national rate | $737.49 |
| 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 | $737.49 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,312.85 |
Common denial reasons
The recurring reasons claims for CPT 25443 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established — no documented prior failed treatment or inadequate imaging in the record
- Laterality mismatch between operative note and claim (modifier LT or RT missing or incorrect)
- Bundling denial when scaphoid excision or wrist arthroscopy is billed same-day without a distinct anatomic site modifier
- Global period conflict — post-op E/M billed without modifier 24 within the 90-day window
- Implant charges billed separately without coordination with the facility, causing duplicate payment edits
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01Can 25443 be billed with a wrist arthroscopy on the same day?
02What ICD-10 codes support medical necessity for 25443?
03Is modifier 50 appropriate for bilateral scaphoid arthroplasty?
04How does the 90-day global period affect post-op cast management billing?
05When is modifier 22 appropriate for 25443?
06What is the difference between 25443 and a proximal row carpectomy (25215)?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 03cms.govhttps://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 04cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 05fastrvu.comhttps://fastrvu.com/cpt/25443
- 06aapc.comhttps://www.aapc.com/codes/cpt-codes/25443
- 07eatonhand.comhttps://www.eatonhand.com/coding/n25443.htm
Mira AI Scribe
Mira's AI scribe captures the implant name, size, and fixation method from dictation, along with the surgical approach, laterality, and the preoperative diagnosis driving the prosthetic choice (nonunion, AVN, carpal collapse). That prevents the most common audit flag on 25443: an operative note that confirms a procedure was done but doesn't justify why prosthetic replacement was chosen over arthrodesis or simple excision.
See how Mira captures CPT 25443 documentation