Closed treatment of a carpal scaphoid fracture without manipulation — the wrist is immobilized without any hands-on fracture reduction attempt.

Verified May 8, 2026 · 5 sources ↓

Medicare: $350.71
Total RVUs: 10.5
Global, days: 90
Region: Wrist

Drawn from CMSCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Imaging confirming scaphoid fracture location (proximal pole, waist, or distal) and displacement status
Explicit statement that no manipulation was performed and clinical rationale for non-operative management
Type of immobilization applied — thumb spica cast vs. splint — and extent of immobilization
Date of injury and mechanism, to establish fracture acuity and timeline for payer audit purposes
Neurovascular exam findings of the wrist and hand documented in the operative or procedure note
Follow-up plan including anticipated imaging schedule for union assessment

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 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25622 covers closed treatment of a carpal scaphoid (navicular) fracture when no manipulation is performed. The treating physician confirms the fracture diagnosis, applies immobilization (typically a thumb spica cast or splint), and manages the fracture non-operatively without any reduction maneuver. Because scaphoid fractures carry a high nonunion risk, documentation must establish the fracture pattern, displacement status, and the clinical rationale for non-operative management without manipulation.

The 90-day global period covers the initial cast application, all routine follow-up visits, cast changes, and fracture reassessment through day 90. Any separately identifiable E/M visit on the day of treatment requires modifier 25 on the E/M. Imaging obtained to confirm diagnosis is separately reportable — it is not bundled into 25622 — but confirm your MAC's policy if imaging and treatment occur on the same date.

Scaphoid fractures are frequently missed or delayed in diagnosis; payers audit these claims closely when ICD-10 diagnosis codes reflect an acute fracture but the encounter date lags the injury date. Document the fracture acuity, mechanism, and why manipulation was not indicated. If the fracture later requires manipulation or surgery within the global, use modifier 58 (staged or related procedure) for the upgraded service.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.72
Practice expense RVU	7.24
Malpractice RVU	0.54
Total RVU	10.5
Medicare national rate	$350.71
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	$350.71
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 25622 get rejected.

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

Missing or mismatched ICD-10 fracture code — using a 'subsequent encounter' diagnosis code (S suffix) on an initial treatment claim
Unbundling denial when the treating physician separately bills an E/M on the same day without modifier 25
Global period conflict when a follow-up visit or repeat imaging is billed without acknowledging the 90-day global
Lack of documentation that manipulation was not performed, leading payer to question whether 25624 (with manipulation) was the appropriate code
Delayed diagnosis claims denied for medical necessity when documentation does not explain the gap between injury date and treatment date

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the global period for 25622 and what does it include?

25622 carries a 90-day global. It covers the fracture treatment visit, cast or splint application, all routine follow-up visits, cast changes, and fracture reassessment through day 90. Unrelated E/M services in that window require modifier 24.

02Can I separately bill for the X-rays taken on the same day as treatment?

Yes. Diagnostic imaging is not bundled into 25622. Bill the appropriate radiology code separately. Confirm with your MAC that imaging and treatment on the same date are both payable without a modifier requirement — most allow it, but local policies vary.

03If the fracture later needs surgery within the 90-day global, how do I bill the OR case?

Use modifier 58 on the surgical procedure code. Modifier 58 signals a staged or related procedure performed during the global period of a prior service — it reopens payment and starts a new global.

04What is the difference between 25622 and 25624?

25622 is closed treatment without manipulation; 25624 is closed treatment with manipulation. The operative note must explicitly state whether reduction was or was not attempted. Billing 25622 when manipulation occurred — or vice versa — is the primary audit risk for this code family.

05Is modifier 25 needed if I see the patient in the office and treat the fracture on the same day?

Yes. If you perform a separately identifiable E/M beyond the decision to treat and the fracture management itself, append modifier 25 to the E/M code. Without it, the E/M will deny as bundled into the fracture care global.

06How does site of service affect payment for 25622?

There is a meaningful payment difference between the hospital outpatient department (HOPD) and ASC settings — see the Site of Service comparison table on this page. Physician work RVUs are the same regardless of setting, but facility fees differ substantially.

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 fracture location (proximal pole, waist, or distal), displacement status from imaging, the specific immobilization device applied, confirmation that no manipulation was performed, and the clinical rationale for non-operative management. This prevents the most common 25622 audit flag: operative notes that omit the 'no manipulation' statement, which opens the door to a downcode challenge or an upcoding allegation to 25624.

See how Mira captures CPT 25622 documentation