Closed treatment of a radiocarpal or intercarpal dislocation involving one or more bones, performed with manipulation and without surgical incision.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $445.90
- Work RVU
- 4.86
- 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 6 cited references ↓
- Specify which joint was dislocated — radiocarpal, midcarpal, or a named intercarpal articulation (e.g., lunotriquetral, scapholunate)
- Document the mechanism of injury and clinical/radiographic confirmation of dislocation pre-reduction
- Record the manipulation technique and degree of reduction achieved, confirmed by post-reduction imaging
- Note the immobilization method applied (splint type, cast, position of immobilization) and any sedation or anesthesia used
- If multiple bones were dislocated, identify each bone — the code covers one or more, but the note should support the complexity billed
- Confirm no surgical incision was made — closed treatment is a prerequisite for this code
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 6 cited references ↓
CPT 25660 covers closed, manipulation-based reduction of radiocarpal or intercarpal dislocations — one or more bones — at the wrist. No incision is made. The surgeon manually realigns the dislocated carpal or radiocarpal articulation, typically followed by splint or cast immobilization. These injuries usually result from high-energy impact and are relatively uncommon compared to distal radius fractures.
The 90-day global period applies. That window includes the day-before visit, the procedure itself, and all routine follow-up through day 90 — cast checks, splint changes, and repeat imaging interpreted in the context of post-reduction management. Any E/M for an unrelated condition during that period requires modifier 24. If a separate, significant E/M is furnished the same day as the reduction, append modifier 25.
The open-treatment counterpart is 25670. If the closed reduction fails and you convert to open treatment at a later date within the global period, that would be a staged/related procedure — bill with modifier 58. If the reduction must be repeated by the same surgeon, modifier 76 applies; by a different surgeon, modifier 77.
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 (4.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.35) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 4.86 |
| Practice expense RVU | 7.44 |
| Malpractice RVU | 1.05 |
| Total RVU | 13.35 |
| Medicare national rate | $445.90 |
| 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 | $445.90 |
HOPD (APC 5111) Hospital outpatient department | $252.01 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $135.54 |
Common denial reasons
The recurring reasons claims for CPT 25660 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoded to 25670 (open treatment) without operative documentation supporting an incision — payers audit the operative note for incision language
- Unbundling: billing a same-day E/M without modifier 25 when the E/M is not documented as separately identifiable from the reduction encounter
- Laterality absent — claims missing LT or RT modifiers are increasingly rejected by commercial payers even when only one wrist is treated
- ICD-10 mismatch: using a fracture diagnosis code (e.g., S52.xx) instead of a dislocation code (S63.0xx–S63.03x series) for the radiocarpal or intercarpal joint
- Global period conflict: billing a routine follow-up visit without modifier 24 within the 90-day global window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between CPT 25660 and 25670?
02Does CPT 25660 require anesthesia documentation?
03Can I bill 25660 for a perilunate dislocation?
04If the reduction fails and I perform open reduction at a later visit, what modifier applies?
05Do I need LT or RT modifiers for 25660?
06What ICD-10 codes pair with 25660?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02fastrvu.comhttps://fastrvu.com/cpt/25660
- 03cms.govhttps://www.cms.gov/files/document/r13033cp.pdf
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/25660
- 05eatonhand.comhttps://www.eatonhand.com/coding/n25660.htm
- 06aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/
Mira Scribe
Mira's AI scribe captures the dislocated joint name (radiocarpal vs. intercarpal), number of bones involved, manipulation technique, post-reduction imaging result, and immobilization method from the procedural dictation. That prevents the two most common audit flags for 25660: a vague joint descriptor that can't support the closed-versus-open distinction, and missing documentation of manipulation when payers challenge whether a reduction was actually performed.
See how Mira captures CPT 25660 documentation