Arthroplasty of the intercarpal or carpometacarpal joints using interposition technique, such as tendon graft placement, to restore joint mobility and cushion the arthritic joint space.

Verified May 8, 2026 · 7 sources ↓

Medicare: $743.84
Total RVUs: 22.27
Global, days: 90
Region: Wrist

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Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the joint operated on (e.g., thumb CMC, index CMC, intercarpal) — 'wrist arthroplasty' alone is insufficient.
Name the procedure using recognizable terminology: LRTI, CMC resection arthroplasty, interposition arthroplasty, or Eaton procedure — operative notes that only use informal nicknames without anatomic context are audit flags.
Confirm interposition technique and graft material used (e.g., palmaris longus, APL slip, FCR tendon).
If suspension was also performed, document the suspension method explicitly — that triggers 25448, not 25447.
Document whether the trapezium, trapezoid, or both bones were removed; removal of both supports a separate code for the second bone with modifier 59.
If tendon graft was harvested through a separate incision, document the harvest site and approach to support billing 20924.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25447 covers interposition arthroplasty at the intercarpal or carpometacarpal (CMC) joints — most commonly the thumb CMC joint affected by basal joint arthritis. The surgeon removes arthritic bone (typically the trapezium), then interposes a soft-tissue spacer, most often a tendon graft, into the joint space to restore function. Surgeons document this procedure under several names: CMC resection arthroplasty, LRTI (ligament reconstruction tendon interposition), Eaton procedure, or thumb CMC stabilization. All of those map to 25447 when the work involves interposition without suspension.

As of CPT 2025, 25447 was revised to clarify it covers interposition only — not suspension. When the procedure includes suspension via tendon transfer, use 25448 instead. The two codes cannot be reported together, and neither can be reported with 25310 or 26480 when performed for intercarpal or CMC arthroplasty. Trapezium excision is bundled into 25447; removal of a second bone (e.g., trapezoid) can be reported separately with modifier 59. If the tendon graft is harvested through a separate incision, add 20924.

The 90-day global period covers all routine post-op management through day 90. Unrelated E/M visits in that window require modifier 24. Additional procedures performed at the same session — such as MCP fusion (26850) or capsulodesis (26516) — are billable with modifier 51.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.24
Practice expense RVU	10.07
Malpractice RVU	1.96
Total RVU	22.27
Medicare national rate	$743.84
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	$743.84
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25447 get rejected.

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

Billing 25447 and 25448 together — mutually exclusive codes per CPT 2025 parenthetical guidelines.
Reporting 25447 with 26480 or 25310 for the same arthroplasty — bundled per CPT 2025 guidelines.
Operative note uses only informal surgeon shorthand (e.g., 'thumb LRTI') without specifying joint, approach, or technique, leading to medical necessity or specificity denials.
Billing 20924 for tendon graft harvest when no separate incision was made — graft harvested through the primary incision is not separately reportable.
Trapezium excision billed separately alongside 25447 — single-bone removal is included in the base code.

Frequently asked questions

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

01Is trapezium removal bundled into 25447?

Yes. Removal of one bone — the trapezium or trapezoid — is included in 25447. If the surgeon removes both bones, the second bone removal can be reported separately with modifier 59 per AAOS Global Service Data guidance.

02When do I use 25448 instead of 25447?

Use 25448 when the procedure includes CMC suspension in addition to interposition — for example, tendon weave, suture button, or anchor-based suspension between the metacarpals. The two codes cannot be reported together.

03Can I report 20924 for tendon graft harvest alongside 25447?

Only if the graft was obtained through a separate incision. Harvest through the primary operative incision is not separately reportable. Document the harvest site and incision location clearly.

04The surgeon dictated 'LRTI' — does that map to 25447 or 25448?

LRTI historically mapped to 25447. As of CPT 2025, the answer depends on whether suspension was performed. If the case included tendon-based or implant-based suspension, use 25448. If interposition only, 25447 is correct. Review the operative note for suspension language.

05Can I bill 26850 (MCP arthrodesis) at the same session as 25447?

Yes, if the surgeon performed fusion of the metacarpophalangeal joint for stabilization at the same session. Report 26850 with modifier 51 alongside 25447.

06What is the global period for 25447, and what does it include?

25447 carries a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op visits through day 90. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures within the global window.

07Was 25447 changed in 2025?

Yes. CPT 2025 revised 25447 to clarify it covers interposition only, not suspension. Simultaneously, new code 25448 was introduced for suspension arthroplasty. Coders who used to bill 25447 + 26480 together should now evaluate whether 25448 applies.

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 joint name and level (thumb CMC, intercarpal), the procedure descriptor used by the surgeon (LRTI, Eaton, CMC resection arthroplasty), graft material and harvest site, whether suspension was performed, and the number of bones removed. That specificity prevents the most common denial: insufficient documentation to distinguish 25447 from 25448, or to justify a separately reported tendon harvest or second-bone excision.

See how Mira captures CPT 25447 documentation