Arthroplasty of the wrist with prosthetic replacement of the lunate bone, performed for conditions such as avascular necrosis of the lunate (Kienböck disease).

Verified May 8, 2026 · 6 sources ↓

Medicare: $759.54
Total RVUs: 22.74
Global, days: 90
Region: Wrist

Drawn from CMSFastrvuAAPCPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis supporting lunate replacement — specifically avascular necrosis (Kienböck disease) stage and radiographic grading (Lichtman classification or equivalent)
Operative note naming the prosthetic implant used (manufacturer, material, size) and confirming only the lunate was replaced
Documentation of failed conservative treatment or clinical rationale for surgical intervention at this stage
Intraoperative confirmation that ligamentous and carpal alignment were assessed, with findings recorded
Laterality clearly documented (right vs. left wrist) in both the operative note and 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 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25444 covers surgical replacement of the lunate bone in the wrist with a prosthetic implant. The lunate is the most commonly affected carpal bone in avascular necrosis, and when conservative management fails or disease progression is advanced (Lichtman stage III-IV), prosthetic lunate replacement is a motion-preserving alternative to more extensive salvage procedures such as proximal row carpectomy or total wrist fusion.

The procedure sits in the same family as 25443 (scaphoid replacement) and 25445 (trapezium replacement), all under the wrist arthroplasty series. 25444 is distinct from 25446 (total wrist arthroplasty), which replaces the entire radiocarpal joint. Billing 25444 when a total wrist prosthesis is implanted — or vice versa — is a common upcoding flag. The operative note must name the specific implant and confirm only the lunate was replaced.

The 90-day global period means all routine post-op wrist care, splint changes, and follow-up visits through day 90 are bundled. Any service unrelated to the lunate replacement during that window requires modifier 24 (E&M) or 79 (unrelated procedure). Modifier 58 applies if a staged procedure was planned and documented preoperatively.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.13
Practice expense RVU	9.46
Malpractice RVU	2.15
Total RVU	22.74
Medicare national rate	$759.54
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	$759.54
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$11,037.13

Common denial reasons

The recurring reasons claims for CPT 25444 get rejected.

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

Misidentification of procedure — billing 25444 when 25446 (total wrist arthroplasty) or 25447 (interposition arthroplasty) better describes what was actually performed
Insufficient diagnosis specificity — Kienböck disease requires ICD-10 coding to the correct stage; a generic wrist pain or unspecified necrosis code frequently triggers medical necessity review
Post-op services billed without modifiers during the 90-day global period, causing automatic bundling denials
Laterality omitted or mismatched — payers compare LT/RT modifier on the claim against prior imaging or prior-auth records
Implant cost not separately documented when a pass-through or device credit is expected by the facility payer

Frequently asked questions

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

01When should I use 25444 vs. 25446?

Use 25444 when only the lunate is replaced with a prosthesis. Use 25446 when a total wrist prosthesis replaces the entire radiocarpal joint. Billing 25446 for an isolated lunate replacement — or 25444 for a total wrist — is an overcoding/undercoding error that auditors catch by comparing the operative note's implant record to the claim.

02Does 25444 carry a global period, and what's included?

Yes — 90-day global. It includes the day-before pre-op visit, the surgery itself, and all routine post-op wrist care through day 90. Splint changes, suture removal, and standard follow-up are bundled. Use modifier 24 for unrelated E&M visits and modifier 79 for unrelated procedures during that window.

03What ICD-10 codes are typically paired with 25444?

M93.1 (Kienböck disease in adults) is the primary diagnosis driver. Some payers also accept osteonecrosis codes under M87.x for the carpus. Avoid unspecified wrist pain codes — they fail medical necessity screening for a prosthetic arthroplasty at this RVU level.

04Can 25444 and 25443 be billed together if both the lunate and scaphoid are replaced in the same session?

Theoretically yes, with modifier 51 on the secondary code, but this is rare and will draw scrutiny. The operative note must clearly describe two separate prosthetic implants placed for independent pathology. If the procedure more accurately reflects a total or partial wrist reconstruction, 25446 or 25447 may better describe the work.

05Is prior authorization typically required for 25444?

Most commercial payers and Medicare Advantage plans require prior auth for wrist arthroplasty. Submit the Lichtman staging, failed conservative treatment history, and operative plan together. Missing staged documentation is the most common reason auth is delayed or denied on initial submission.

06What modifier applies if the surgeon returns to the OR within the global period for a wound complication?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 here; that is for unrelated procedures. Confusing 78 and 79 is a codeable distinction that directly affects whether the return visit pays.

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 Lichtman stage from dictation, names the prosthetic implant with manufacturer and size, records the surgical approach, and documents the intraoperative carpal alignment assessment. That prevents the two most common audit flags for 25444: an operative note that lacks implant specifics (triggering implant-cost disputes) and a missing diagnosis stage that payers use to deny medical necessity.

See how Mira captures CPT 25444 documentation