Open treatment of a carpal fracture other than the scaphoid, performed on a single bone

Verified May 8, 2026 · 5 sources ↓

Medicare: $546.10
Work RVU: 7.23
Global, days: 90
Region: Wrist

Drawn from CMSHhsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific carpal bone treated by name (e.g., hamate, capitate, lunate) — 'carpal fracture' alone is insufficient
Confirm the operative note describes open surgical exposure with direct visualization of the fracture site
Document the reduction technique and any internal fixation method used (K-wire, headless screw, plate and screws)
Pre-operative imaging (X-ray or CT) establishing fracture diagnosis and confirming the bone involved is not the scaphoid
If billing 25645 more than once on the same date, document each bone as a distinct fracture at a separate anatomic site

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 79 Unrelated during global 80 Assistant surgeon XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25645 covers open surgical treatment of a carpal fracture — any carpal bone except the scaphoid — with direct visualization, reduction, and typically internal fixation. Common targets include the hamate, capitate, trapezium, trapezoid, lunate, triquetrum, and pisiform. The code is reported per bone; if two separate non-scaphoid carpal fractures are treated openly at the same session, report 25645 twice with modifier 59 (or XS) to indicate distinct anatomic sites, supported by documentation that each bone required independent open treatment.

The 90-day global period covers the surgery, the day-before visit, and all routine post-op management through day 90. Separate E/M visits during that window require modifier 24 (unrelated) or modifier 57 if a new surgical decision is made. Fluoroscopy used intraoperatively to confirm reduction is bundled — do not separately report fluoroscopy codes. If fixation hardware is placed (K-wires, screws, plates), that work is included in 25645; there is no add-on for standard internal fixation within this code family.

Distinguish 25645 from the scaphoid-specific open code (25628) and the closed treatment codes (25630 without manipulation, 25635 with manipulation). Payers audit for misuse of 25645 when scaphoid fractures are the operative finding — if the scaphoid is the fractured bone, 25628 is the correct code regardless of operative complexity.

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 (7.23) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.35) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.23
Practice expense RVU	7.59
Malpractice RVU	1.53
Total RVU	16.35
Medicare national rate	$546.10
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	$546.10
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25645 get rejected.

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

Scaphoid fracture coded as 25645 instead of the scaphoid-specific code 25628 — payers cross-reference operative note bone identification
Bilateral or multi-bone billing without modifier 59 or XS to establish distinct anatomic sites, triggering NCCI bundling denial
Fluoroscopy billed separately on the same date — intraoperative fluoroscopy is bundled into open fracture treatment codes
Missing or non-specific operative note — documentation that says 'open carpal fracture repair' without naming the bone will not survive audit
Post-op E/M billed within the 90-day global without modifier 24, causing automatic denial as a bundled service

Frequently asked questions

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

01Can 25645 be reported twice if two non-scaphoid carpal bones are treated open at the same session?

Yes. Report 25645 for each bone treated. Add modifier 59 or XS on the second code to indicate a distinct anatomic site. The operative note must document each bone as a separate fracture requiring independent open treatment — not just mention two bones in passing.

02What is the global period for 25645 and what does it include?

The global period is 90 days. It includes the day before surgery, the operative session, and all routine post-op visits, splint or cast changes, and stitch removals through day 90. Unrelated E/M visits in that window need modifier 24.

03If the surgeon discovers during surgery that the hamate hook is fractured — originally thought to be a soft tissue injury — can modifier 22 be used?

Modifier 22 is appropriate when the work performed was substantially greater than typical. An unexpected fracture pattern requiring additional dissection or fixation difficulty can support modifier 22 — but you need the operative note to detail specifically why the case exceeded the standard. Attach a cover letter with supporting documentation.

04Is fluoroscopy separately billable when used to confirm reduction intraoperatively?

No. Per CMS NCCI policy, fluoroscopy performed during an open surgical procedure is integral to the procedure and cannot be separately reported. This applies to 25645 regardless of how many fluoroscopic views were obtained.

05What ICD-10 diagnosis codes are typically paired with 25645?

Common pairings include S62.101A–S62.109A (fracture of unspecified carpal bone), S62.111A–S62.119A (fracture of triquetrum), S62.121A–S62.129A (fracture of lunate), S62.151A–S62.159A (fracture of hamate), and S62.181A–S62.189A (fracture of other carpal bones). Use the most specific code matching the operative finding, with the appropriate 7th character for encounter type.

06How does 25645 differ from 25628?

25628 is the open treatment code specific to scaphoid fractures. 25645 covers every other carpal bone. If the fractured bone is the scaphoid, 25628 is the correct code — using 25645 for a scaphoid fracture is a codable error that payers will flag.

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, fracture pattern, surgical approach, reduction technique, and fixation hardware from the surgeon's dictation and maps those directly to 25645. This prevents the most common audit flag for this code — an operative note that names the procedure but not the bone, which payers treat as insufficient specificity for a non-scaphoid carpal fracture claim.

See how Mira captures CPT 25645 documentation