Closed treatment of a trans-scaphoperilunar fracture-dislocation of the wrist, with manipulation to restore alignment without surgical opening of the site.

Verified May 8, 2026 · 6 sources ↓

Medicare: $519.05
Work RVU: 6.07
Global, days: 90
Region: Wrist

Drawn from CMSAMAEmednyCgsmedicare

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 and clinical findings confirming trans-scaphoperilunar fracture-dislocation pattern
Imaging (pre- and post-reduction radiographs or fluoroscopy) documenting displacement and confirming reduction achieved
Description of manipulation technique and specific maneuvers used to reduce the dislocation
Type and method of post-reduction immobilization applied (cast, splint, sugar-tong, etc.)
Post-reduction neurovascular status of the hand and wrist
Laterality documented explicitly (left, right, or bilateral) to support LT/RT modifier assignment

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 50 Bilateral procedure 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25680 covers closed reduction of a trans-scaphoperilunar fracture-dislocation — a complex wrist injury involving the scaphoid, lunate, and surrounding carpal relationships. The physician manipulates the displaced bones back into anatomic alignment without making a surgical incision. A cast, splint, or other external stabilization device is applied as part of the procedure and is included in the code; it is not separately billable.

This code carries a 90-day global period. All routine follow-up, dressing changes, and post-reduction checks through day 90 are bundled. Any E&M visit during the global period for a condition unrelated to the fracture-dislocation requires modifier 24. If satisfactory alignment is lost and the same provider performs a subsequent re-reduction, append modifier 76 to report the repeat procedure.

If closed treatment fails and the surgeon converts to open treatment (25685) during the same session or a later encounter, use modifier 58 (staged/related procedure in the postoperative period) rather than 78, which is reserved for unplanned returns to the OR. Document fluoroscopic confirmation of reduction — payers frequently request imaging reports to verify that manipulation was performed and alignment achieved.

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 (6.07) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.54) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.07
Practice expense RVU	8.17
Malpractice RVU	1.3
Total RVU	15.54
Medicare national rate	$519.05
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	$519.05
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 25680 get rejected.

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

Missing or inadequate post-reduction imaging to confirm manipulation was performed — payers treat it as treatment without manipulation
Laterality modifier absent (LT or RT), triggering claim suspension or denial on bilateral-edit review
Separate billing of casting or splinting supplies as a procedure code when the stabilization is bundled into 25680
Upcoding to open treatment code 25685 when operative note describes closed reduction, or vice versa — code must match the actual treatment type documented
E&M visit billed during the 90-day global period without modifier 24 for an unrelated condition

Frequently asked questions

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

01Is casting or splint application separately billable with 25680?

No. Application of a cast, splint, or strapping to stabilize the fracture-dislocation is included in 25680 per CPT musculoskeletal guidelines. Supply codes (Q codes) for the cast or splint material may be billed separately if payer policy allows, but the application work is bundled.

02What modifier do I use if the same physician performs a second closed reduction because alignment was lost?

Append modifier 76 (repeat procedure by same physician) to 25680 for the re-reduction. Document why re-reduction was necessary — loss of alignment on interval imaging is the standard justification.

03If closed reduction fails intraoperatively and we convert to open treatment, how do I code it?

Bill 25685 (open treatment) only — do not stack 25680 and 25685 for the same wrist on the same date. The open code describes the definitive procedure. If conversion happens during a later encounter within the global period, use modifier 58 on 25685.

04Does the 90-day global include the initial ED or office evaluation where the injury was diagnosed?

The global period begins on the day of surgery (the date 25680 is performed). A separately documented E&M on the day before surgery, or an E&M on the day of surgery before the decision to treat, may be separately billable with modifier 57. The pre-operative work-up prior to that is outside the global.

05Can I bill 25680 bilaterally if both wrists are treated at the same session?

Yes. Report 25680 with modifier 50 for bilateral treatment at the same session, or with LT and RT on separate lines per payer preference. Document both wrists in the operative note with individual reduction details and post-reduction imaging for each side.

06What ICD-10 diagnosis codes align with 25680?

The primary diagnosis should reflect a trans-scaphoperilunar or perilunate fracture-dislocation pattern. Use the most specific S-code available for wrist fracture-dislocation with laterality (e.g., S62 series for carpal fractures with associated dislocation components). Mismatched or overly generic diagnosis codes are a leading cause of initial denial on this code.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the injury pattern (trans-scaphoperilunar fracture-dislocation), the specific manipulation technique performed, laterality, fluoroscopic or radiographic confirmation of reduction, and the type of immobilization applied. That documentation set closes the gap auditors exploit when they dispute whether manipulation was truly performed — preventing downcoding to a treatment-without-manipulation code or outright denial for insufficient operative detail.

See how Mira captures CPT 25680 documentation