Open surgical treatment of a radiocarpal or intercarpal dislocation involving one or more carpal bones at the wrist

Verified May 8, 2026 · 6 sources ↓

Medicare: $580.17
Work RVU: 7.89
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury documenting the high-energy force sufficient to cause radiocarpal or intercarpal dislocation
Preoperative imaging (X-ray, CT, or MRI) confirming dislocation of one or more named carpal bones with interpretation in the record
Operative note identifying the specific bone(s) reduced by anatomic name (e.g., lunate, capitate, scaphoid) and the surgical approach used
Description of fixation method applied — K-wires, screws, or other hardware — including size and placement details
Intraoperative fluoroscopy findings confirming reduction and hardware position, if fluoroscopy was used
Post-reduction neurovascular status documentation including median and ulnar nerve function assessment

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 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side 50 Bilateral procedure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25670 covers open treatment of radiocarpal or intercarpal dislocation — one or more bones — at the wrist. The surgeon opens the wrist, reduces the dislocated bone(s) under direct visualization, and typically stabilizes the construct with internal fixation (Kirschner wires, screws, or both). Radiocarpal and intercarpal dislocations are high-energy injuries; closed reduction is often inadequate, making open fixation the standard approach when ligamentous disruption or bony instability is significant.

The 90-day global period covers all routine postoperative management, cast or splint checks, wire removal if performed in the office, and wound care through day 90. Any visit or procedure unrelated to the dislocation repair during that window requires modifier 24 (E/M) or 79 (unrelated procedure). If an unplanned return to the OR for a related complication — such as hardware failure or infection — is necessary within the global, use modifier 78.

This code is site-of-service sensitive. The HOPD and ASC payment differentials are material; see the Site of Service comparison table. Bilateral wrist dislocation repair is rare but theoretically possible — if performed, report with modifier 50 (or LT/RT on separate lines in the ASC setting per CMS NCCI Chapter 4 bilateral billing guidance).

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 (7.89) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.37) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.89
Practice expense RVU	7.8
Malpractice RVU	1.68
Total RVU	17.37
Medicare national rate	$580.17
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	$580.17
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 25670 get rejected.

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

Operative note states 'wrist dislocation reduced and fixed' without identifying which specific carpal bone(s) were involved, failing to support the code descriptor
Missing or inadequate preoperative imaging in the record — payers require confirmatory imaging to establish medical necessity for open versus closed treatment
Global period billing conflict: a related E/M visit or procedure billed within the 90-day window without modifier 24 or 79 triggers automatic denial
ICD-10 diagnosis code mismatch — using a sprain or fracture code instead of the appropriate dislocation code (S63.0xx series) causes CPT-to-diagnosis pairing rejection
Unbundling of fluoroscopic guidance when it was used intraoperatively — fluoroscopy during an open surgical procedure is integral and cannot be separately reported

Frequently asked questions

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

01Can 25670 be billed with a distal radius fracture repair code on the same day?

Yes, if the dislocation and fracture are distinct injuries treated as separate procedures. Append modifier 59 (or XS for a separate anatomic structure argument) to the secondary code and ensure the operative note documents each procedure distinctly. Check current NCCI PTP edits for the specific code pair before billing.

02What ICD-10 codes pair correctly with 25670?

Use codes from the S63.0xx series for radiocarpal or intercarpal dislocation. S63.001A through S63.096A cover initial encounter by laterality and specific joint. Avoid S62.xx (fracture) or S63.5xx (sprain) as the primary diagnosis — those create a CPT-to-diagnosis mismatch that triggers denial.

03Does the 90-day global include K-wire removal?

Wire removal performed in the office within the global period is bundled — you cannot bill separately. If wire removal requires a return trip to the OR, bill with modifier 78 (unplanned related procedure in the global period) and the appropriate removal code.

04When is modifier 22 appropriate for 25670?

Use modifier 22 when the procedure is substantially more work than typical — for example, a complex perilunate dislocation with multiple bone reductions, extensive ligamentous repair, and prolonged operative time. The operative note must document the increased complexity, time, and effort explicitly. Attach a cover letter to the claim explaining the added work.

05Can a PA or NP bill 25670 independently?

No. Open fracture and dislocation procedures must be performed by or directly supervised by a physician. A PA or NP assisting the surgeon may be reported with modifier AS on the assistant-surgeon line, subject to payer policy on mid-level assistant billing.

06Is modifier 62 (co-surgery) ever appropriate for 25670?

Rarely, but possible when a hand surgeon and a vascular surgeon — or two distinctly specialized surgeons — work simultaneously on the same wrist injury requiring concurrent expertise. Both surgeons bill 25670 with modifier 62. Document in both operative notes why co-surgery was medically necessary and that each surgeon performed a distinct component requiring their specialty.

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 bones dislocated (radiocarpal vs. intercarpal, named bones), the mechanism of injury, the surgical approach by name, fixation hardware type and size, and intraoperative fluoroscopy findings from dictation. This prevents the most common audit flag for 25670: an operative note that describes a generic 'wrist dislocation' without naming the reduced bones, which auditors treat as insufficient to support the open dislocation code.

See how Mira captures CPT 25670 documentation