Surgical removal of the trapezium bone at the base of the thumb with placement of a prosthetic implant to replace it, restoring thumb CMC joint function.

Verified May 8, 2026 · 6 sources ↓

Medicare: $664.01
Total RVUs: 19.88
Global, days: 90
Region: Wrist

Drawn from CMSAAPCEmednyNIHFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note confirming complete trapezium excision and prosthetic implant placement — not just tendon interposition
Preoperative imaging (X-ray or MRI) demonstrating advanced CMC arthritis or structural pathology warranting prosthetic replacement
Implant documentation: manufacturer, model, and lot number of the prosthetic trapezium
Laterality clearly stated (left, right, or bilateral) with corresponding modifier applied to the claim
Failed conservative treatment history — injections, splinting, or therapy — supporting medical necessity
Anesthesia type and patient positioning recorded in the operative note

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 59 Distinct service 62 Co-surgeons 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 25445 covers trapezial arthroplasty using a prosthetic implant — the surgeon excises the diseased trapezium and seats an artificial replacement to reconstruct the thumb's basal joint. It's most often indicated for advanced carpometacarpal (CMC) arthritis that hasn't responded to conservative management. The code is distinct from 25447 (interposition arthroplasty using tendon) and 25448 (suspension arthroplasty with tendon transfer); if the trapezium is excised and soft tissue alone fills the space, 25445 is not the right code.

The 90-day global period covers the day-before visit, the operative session, and all routine post-op management through day 90. Splint adjustments, wound checks, and occupational therapy orders written by the operating surgeon are all bundled. Unrelated problems treated in that window require modifier 24; a separately identifiable E/M on the day of surgery needs modifier 25 on the E/M.

Bilateral trapezial arthroplasty in a single session is uncommon but not unknown in rheumatoid disease. If both wrists are operated, append modifier 50 and bill a single line, or bill LT and RT on separate lines per payer preference — confirm with each commercial payer before submitting. If a second surgeon performs a distinct portion of the procedure, modifier 62 applies with co-surgeon documentation from both.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.63
Practice expense RVU	8.39
Malpractice RVU	1.86
Total RVU	19.88
Medicare national rate	$664.01
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	$664.01
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,097.36

Common denial reasons

The recurring reasons claims for CPT 25445 get rejected.

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

Medical necessity not established — no documentation of failed conservative treatment prior to surgical intervention
Implant not separately itemized or device documentation absent, triggering implant cost denial or downcoding
Wrong code selected — payer audits flag 25445 when the operative note describes tendon interposition only (correctly coded as 25447 or 25448)
Laterality modifier missing or inconsistent with the procedure note, causing claim rejection or pend
Routine post-op E/M billed without modifier 24 during the 90-day global period, resulting in automatic denial

Frequently asked questions

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

01What's the difference between 25445 and 25447?

25445 requires placement of a prosthetic implant to replace the trapezium. 25447 covers interposition arthroplasty using soft tissue — typically a tendon rolled into the space after trapezial excision. If no prosthesis is used, 25445 is incorrect.

02Can 25445 and 25448 be billed together for the same thumb?

Not for the same procedure on the same joint. 25448 adds suspension and tendon transfer/transplant to an interposition. If a prosthetic trapezium is placed AND a tendon transfer is performed as a distinct component, document each separately and evaluate NCCI edits before appending modifier 59.

03Is 25445 ever performed bilaterally?

Rarely, but it occurs in bilateral CMC arthritis — most commonly in rheumatoid arthritis patients. Bill modifier 50 on a single line or LT/RT on separate lines depending on payer. Medicare accepts modifier 50 on one line; many commercial payers prefer separate lines.

04What happens if the surgeon removes a failed prior prosthesis and places a new one?

If the original prosthesis has failed and is being revised, consider 25449 (revision of arthroplasty including implant removal). If 25445 is used for the revision, document why 25449 doesn't apply or append modifier 22 if the complexity was substantially greater than a primary procedure.

05Does the 90-day global include occupational therapy referrals?

The global covers the surgeon's own post-op management services. Occupational therapy billed by a separate OT provider under their own NPI is not bundled into the global — those claims are not affected. Only the operating surgeon's E/M and related visits are subject to the 90-day global rules.

06When is modifier 22 appropriate for 25445?

Use modifier 22 when documented circumstances substantially increase operative work — for example, severe scarring from prior surgery, unusual anatomy, or a complex revision scenario. The operative note must explicitly describe what made the case harder and quantify additional time or effort. Without that documentation, payers will deny the upcharge.

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 trapezium excision method, prosthetic implant details (type, manufacturer, fixation technique), laterality, and the approach used to access the basal joint from the surgeon's dictation. That specificity prevents the most common audit flag for 25445 — operative notes that describe a tendon-only interposition, which auditors recode to 25447 or 25448 and claw back the difference.

See how Mira captures CPT 25445 documentation