Closed treatment of a carpal scaphoid fracture with manipulation — no incision made, reduction achieved manually.

Verified May 8, 2026 · 5 sources ↓

Medicare: $549.11
Total RVUs: 16.44
Global, days: 90
Region: Wrist

Drawn from MdclarityAAPCCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm fracture involves the carpal scaphoid specifically — document by bone name, not generic 'wrist fracture'
State explicitly that manipulation was performed and describe the technique; immobilization-only encounters map to 25600, not 25624
Record displacement status, fracture pattern (waist, proximal pole, tubercle), and neurovascular assessment
Document imaging used to confirm fracture and post-reduction alignment (X-ray, CT, or MRI as appropriate)
Note type of immobilization applied (thumb spica cast, short-arm cast, splint) and position of immobilization
If modifier 22 is appended, provide a separate narrative explaining the substantially increased complexity or time

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 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25624 covers closed treatment of a scaphoid fracture with manipulation. The scaphoid is the most commonly fractured carpal bone, typically broken in a fall on an outstretched hand. Under this code, the treating physician reduces the fracture manually — no surgical incision, no internal fixation. Immobilization (cast or splint) applied at the same encounter is included in the global package and is not separately billable.

The 90-day global period means all routine post-reduction visits, cast checks, and splint changes through day 90 are bundled. Any E/M service during that window for an unrelated condition requires modifier 24. If the fracture fails to reduce adequately and open treatment or percutaneous fixation becomes necessary in the same global period, report that with modifier 78 (unplanned return, related procedure).

Scaphoid fractures are notorious for delayed union and avascular necrosis — document fracture pattern, displacement status, and vascularity assessment in the initial note. Payers scrutinize whether manipulation was truly performed or whether the encounter was immobilization-only, which maps to 25600 (without manipulation). The distinction must be explicit in the operative or procedure note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.65
Practice expense RVU	10.79
Malpractice RVU	1
Total RVU	16.44
Medicare national rate	$549.11
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	$549.11
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25624 get rejected.

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

Code billed as 25624 when documentation supports immobilization only — payer downcodes to 25600 (without manipulation)
Fracture site not specified as scaphoid in the note or on the claim; non-specific carpal fracture diagnosis may not crosswalk correctly
Separate billing for cast application or splinting within the same global episode — those services are bundled
E/M billed during the 90-day global without modifier 24 or 25 to indicate unrelated or separately identifiable service
Laterality not indicated on the claim when payer edit requires LT or RT modifier

Frequently asked questions

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

01What is the difference between CPT 25624 and 25600?

25600 is closed treatment of a distal radial fracture without manipulation. 25624 is closed treatment of a carpal scaphoid fracture with manipulation. They involve different bones and different treatment approaches — do not confuse them based on code proximity.

02Is there a code for scaphoid fracture treatment without manipulation?

Yes — CPT 25622 covers closed treatment of a carpal scaphoid fracture without manipulation (immobilization only). If you manipulated the fracture, 25624 is correct. Document the manipulation explicitly or expect a downcode.

03Can I bill separately for the cast or splint applied at the same visit?

No. Cast and splint application is bundled into the fracture care code for the initial encounter. Separate billing for strapping or splinting at the same visit will be denied.

04What happens if the patient needs surgery during the 90-day global?

If the fracture fails closed treatment and you take the patient to open reduction or percutaneous fixation during the global period, report the surgical code with modifier 78 (unplanned return, related procedure during postoperative period). The global clock restarts from the new procedure.

05Do I need LT or RT modifier for 25624?

Medicare does not require laterality modifiers for wrist fracture codes on the professional claim, but many commercial payers do. Check your payer contract. When in doubt, append LT or RT — it never causes a denial on its own and prevents rejections from payers that require it.

06Can an E/M visit on the same day as 25624 be billed?

Only if it is a separately identifiable service beyond the decision to treat the fracture. The decision to perform fracture care requires modifier 57 on the E/M if the visit on that day drove the decision for the procedure. Routine same-day E/M bundled into the fracture care encounter is not separately billable.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures the fracture site (scaphoid, specifying pole or waist), explicit documentation that manipulation was performed and the technique used, post-reduction alignment, imaging confirmation, and immobilization type and position — all in the procedure note. That specificity prevents payers from downgrading the claim to the immobilization-only code or rejecting it for an unspecified carpal fracture diagnosis.

See how Mira captures CPT 25624 documentation