Closed treatment of a carpal bone fracture (excluding the scaphoid) with manipulation, reported per bone treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $520.72
Total RVUs: 15.59
Global, days: 90
Region: Wrist

Drawn from CMSNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific carpal bone(s) fractured by name — 'carpal fracture' alone is insufficient for audit defense.
Confirm the bone is not the scaphoid (navicular); scaphoid fractures map to 25622–25628.
Document manipulation technique and pre/post reduction alignment, including imaging interpretation.
Record post-reduction immobilization type (cast, splint, brace) and the anatomical position used.
If billing multiple units same-day, note each distinct bone treated and confirm separate clinical justification for each.
Document neurovascular status before and after manipulation to support medical necessity and quality of care.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 6 cited references ↓

CPT 25635 covers closed reduction of a non-scaphoid carpal bone fracture where the treating physician performs manual manipulation to restore alignment. The scaphoid (navicular) has its own code family (25622–25628); 25635 applies to all other carpal bones — hamate, capitate, lunate, trapezium, trapezoid, triquetrum, and pisiform. The descriptor includes 'each bone,' meaning if two separate non-scaphoid carpals are manipulated in the same session, you can report 25635 twice with modifier 59 to distinguish the distinct fracture sites.

The 90-day global period covers all routine follow-up, cast changes, and repeat manipulation checks within that window. Any E/M service on the day you decide to proceed with closed manipulation requires modifier 57. If the patient returns within the global period for an unrelated problem, use modifier 24 on the E/M. A staged or planned secondary procedure on the same wrist (e.g., escalation to open fixation) bills with modifier 58 and resets the global clock. An unplanned return to the OR for a related complication uses modifier 78; an unrelated procedure in the global period uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.49
Practice expense RVU	10.14
Malpractice RVU	0.96
Total RVU	15.59
Medicare national rate	$520.72
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	$520.72
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 25635 get rejected.

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

Billing 25635 for a scaphoid fracture — payers remap to the 25622/25624/25628 family and deny the claim.
Multiple units reported without modifier 59 identifying each bone as a distinct fracture site.
Insufficient documentation of manipulation — notes that only reflect casting without evidence of reduction attempt.
E/M billed same-day without modifier 57 when the decision for the procedure was made at that visit.
Imaging CPT codes reported separately when the fluoroscopy used was part of the manipulation itself and not separately documentable as a distinct service.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 25635 for a scaphoid fracture with manipulation?

No. Scaphoid fractures with manipulation map to 25624. Use 25635 only for the other seven carpal bones.

02If I manipulate two separate non-scaphoid carpal fractures in the same session, how do I bill?

Report 25635 twice. Append modifier 59 to the second unit to indicate a distinct fracture site and prevent automatic bundling denial.

03Is fluoroscopy separately billable with 25635?

Only if it is performed and documented as a distinct service unrelated to the manipulation itself. Per NCCI 2026 Chapter 4, if fluoroscopy is inherent to confirming reduction, it is not separately reportable. If it is performed for a separate purpose with its own formal report, it may qualify.

04What modifier applies if I see the patient in the office and decide same-day to perform the closed reduction?

Modifier 57 on the E/M. Because 25635 carries a 90-day global, the decision-for-surgery E/M falls within the major surgery global rule, requiring modifier 57 to be separately payable.

05The patient returns within the 90-day global period and needs open fixation. What modifier applies?

Modifier 58 — staged or related procedure by the same physician during the postoperative period. This resets the global clock. Do not use modifier 78, which is reserved for unplanned returns to the OR for complications of the original procedure.

06Does 25635 differ in payment between hospital outpatient (HOPD) and ASC settings?

Yes. The HOPD and ASC facility payments differ — see the Site of Service comparison table on this page. The physician professional fee is the same regardless of setting, but lower ASC facility rates can affect where the procedure is most economically performed.

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 carpal bone name, confirmation that it is not the scaphoid, the manipulation technique performed, pre- and post-reduction alignment findings, and the immobilization applied. That prevents the most common audit flag — operative or procedure notes that document only casting without explicit evidence of closed reduction, which leads to downcoding or denial.

See how Mira captures CPT 25635 documentation