Closed treatment of a non-scaphoid carpal bone fracture without manipulation, performed at the wrist.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $345.03
- Work RVU
- 2.95
- 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 4 cited references ↓
- Identify the specific carpal bone fractured by name — not just 'carpal fracture' — and confirm it is not the scaphoid
- Imaging report (X-ray or CT) confirming fracture location and ruling out scaphoid involvement
- Documentation that no manipulation was performed and no incision was made
- Type of immobilization applied (cast, splint, brace) and laterality (left vs. right wrist)
- Clinical rationale for closed non-manipulative treatment, including alignment and stability assessment
- Date of injury and mechanism of trauma to support medical necessity
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 4 cited references ↓
CPT 25630 covers closed, non-operative treatment of a fracture involving one of the carpal bones — excluding the scaphoid — where no surgical incision is made and no manipulation of the fracture fragments is performed. The treating provider immobilizes the wrist, typically with a cast or splint, and manages the injury non-surgically. This code applies per bone fractured; if multiple distinct carpal bones are fractured, each may be reported separately with appropriate modifier usage and documentation.
The 90-day global period applies. That window includes the day before and day of service, plus all routine post-op visits, cast checks, and removal of immobilization through day 90. E/M services unrelated to the fracture during that period require modifier 24. A same-day E/M — for example, when fracture care is initiated at the same visit as the initial evaluation — requires modifier 25 on the E/M.
Scaphoid fractures are explicitly excluded from 25630 and report separately under 25622 (without manipulation) or 25624 (with manipulation). Using 25630 for a confirmed scaphoid fracture is a coding error that draws payer scrutiny and audits.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.33) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.95 |
| Practice expense RVU | 6.8 |
| Malpractice RVU | 0.58 |
| Total RVU | 10.33 |
| Medicare national rate | $345.03 |
| 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 | $345.03 |
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 25630 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Fracture documented as 'carpal' without specifying the bone — payers reject unspecific operative or clinical notes
- Scaphoid fracture coded as 25630 instead of the correct 25622 or 25624 series
- E/M billed same-day without modifier 25, triggering automatic bundling denial
- Bilateral fractures reported without modifier 50 or separate line entries with LT/RT, causing duplicate claim flags
- Claim submitted with incorrect global period tracking, leading to post-op visit denials or overpayment takebacks
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Does 25630 include the follow-up visits during the 90-day global period?
02Can 25630 be billed for a scaphoid fracture?
03If the patient has two separate non-scaphoid carpal fractures treated at the same visit, how do you bill?
04When is modifier 22 appropriate for 25630?
05If fracture care was initiated in the ER and the patient follows up in your office, can you bill 25630?
06Is modifier 57 needed when the decision for closed treatment is made the same day as the procedure?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira Scribe
Mira's AI scribe captures the specific carpal bone name from dictation, the laterality, the absence of manipulation, immobilization type applied, and the imaging findings that confirm fracture identity and rule out scaphoid involvement. That prevents the two most common denials for this code: unspecific bone documentation and misidentification as a scaphoid fracture.
See how Mira captures CPT 25630 documentation