Arthroplasty of the intercarpal or carpometacarpal joints using suspension technique, including tendon transfer or transplant with interposition when performed.

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

• Identify the specific joint(s) operated on (e.g., thumb CMC, intercarpal) by name — not just 'wrist joint arthroplasty'.
• Document the suspension method used (anchor, suture button, tendon weave, suture-only) — the code is agnostic to method but audit teams require specificity.
• If tendon interposition was performed, document the tendon source, harvest technique, and placement in the arthroplasty space.
• Confirm trapezium (and/or other carpal bone) removal is documented with technique; removal of one bone is included — if a second bone (e.g., trapezoid) is removed, document the additional work.
• Note neurovascular structures identified and protected (e.g., branches of radial sensory nerve, radial artery) to support complexity.
• Document medical necessity with ICD-10 diagnosis (e.g., primary osteoarthritis of CMC, post-traumatic arthritis) linked directly to the procedure.

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 ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 25448 get rejected.

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

• Billing 25448 with 25447 on the same date for the same joint — these codes are mutually exclusive by CPT parenthetical and NCCI edit.
• Separately reporting 26480 or 25312 for tendon transfer/harvest performed as part of the CMC suspension arthroplasty — both are bundled into 25448.
• Using 25447 for a suspension arthroplasty case (pre-2025 habit) — payers will downcode or deny if the documentation clearly describes a suspension construct.
• Missing or vague operative note documentation (e.g., 'standard suspension performed') without specifying the suspension method or tendon handling.
• ICD-10 diagnosis code mismatch or insufficient medical necessity documentation to support arthroplasty over conservative treatment.