Revision of a previously placed wrist joint arthroplasty, including removal or exchange of the prosthetic implant at the radiocarpal joint.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $932.22
- Total RVUs
- 27.91
- 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 5 cited references ↓
- Operative report from the index wrist arthroplasty, including implant manufacturer, model, and size
- Pre-revision imaging (X-ray, CT, or MRI) showing loosening, periprosthetic fracture, infection, or implant failure
- Documented clinical course — failed conservative management or infectious workup (ESR, CRP, joint aspiration culture) supporting revision
- Intraoperative findings describing component condition, bone stock quality, and reason for revision or exchange
- Implant removal and/or exchange details: which components were removed, revised, or replaced and with what implant system
- Surgical approach documented by name — audit teams flag operative notes that only state 'standard approach'
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 5 cited references ↓
CPT 25449 covers reopening a wrist that has already undergone total or partial joint replacement to revise, remove, or exchange the prosthetic components — typically the radial and/or carpal side implants. The most common drivers are periprosthetic infection, component loosening, implant failure, or instability that has not responded to conservative management. This is a substantially more complex operation than the index arthroplasty: the surgeon must navigate scar tissue, potentially compromised bone stock, and hardware removal before addressing the underlying problem.
The 90-day global period begins on the day of surgery and swallows all routine follow-up through day 90. If the revision itself requires a return to the OR for a related complication within that window — say, wound dehiscence or implant re-seating — bill modifier 78. If the return is for a completely unrelated problem, use modifier 79. Anything billed in the global window without a modifier will be denied as bundled.
Site of service matters significantly here. HOPD and ASC payment rates differ — see the site-of-service comparison on this page. Most payers require documented failure of the index arthroplasty with supporting imaging and clinical notes before authorizing revision; submit those records with the prior auth, not after a denial.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.57 |
| Practice expense RVU | 10.53 |
| Malpractice RVU | 2.81 |
| Total RVU | 27.91 |
| Medicare national rate | $932.22 |
| 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 | $932.22 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 25449 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing prior authorization — most commercial payers and Medicare Advantage plans require pre-approval for wrist revision arthroplasty
- Insufficient documentation of the index arthroplasty failure; payers deny when the clinical record doesn't establish medical necessity for revision
- Global period conflict — routine post-op services billed without modifier 24 or 25 during the 90-day global are auto-denied as bundled
- ICD-10 diagnosis mismatch — using a primary arthroplasty complication code without a laterality-specific implant complication code (T84.0xx series) triggers edits
- Modifier 78 and 79 confusion — returning to the OR for a related complication billed as 79 (unrelated) or vice versa is a common audit flag
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What ICD-10 codes typically support medical necessity for 25449?
02Can 25449 be billed with 25441 or 25447 on the same day?
03Does modifier 22 hold up for an unusually complex revision?
04How does the 90-day global period affect post-op management of complications?
05Is 25449 performed bilaterally in practice, and how do you bill it?
06What's the difference between 25449 and 25250 or 25251 for implant removal?
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 specific implant components removed or exchanged, intraoperative bone stock assessment, the documented reason for revision (infection, loosening, instability), and the surgical approach by name. This prevents the most common denial for 25449: an operative note that describes what was done without establishing why the revision was medically necessary — the evidentiary gap auditors exploit.
See how Mira captures CPT 25449 documentation