Closed treatment of a lunate dislocation at the wrist, performed with manual manipulation to restore bone position without open surgery.

Verified May 8, 2026 · 6 sources ↓

Medicare: $482.31
Work RVU: 5.58
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm dislocation diagnosis with pre-reduction imaging (X-ray or fluoroscopy), specifying lunate displacement pattern (volar vs. dorsal)
Document anesthesia or sedation method used for manipulation (e.g., hematoma block, conscious sedation, regional block)
Record the manipulation technique and number of reduction attempts performed
Post-reduction imaging confirming lunate realignment — fluoroscopy findings should be documented by name and interpretation
Immobilization type, position, and duration prescribed after reduction (e.g., short-arm vs. long-arm cast/splint)
Neurovascular status of the hand before and after reduction, including median nerve assessment given risk of acute carpal tunnel syndrome

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 51 Multiple procedures 52 Reduced services 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25690 describes the non-operative reduction of a dislocated lunate bone — the keystone carpal that sits at the center of the proximal row — using manipulation rather than incision. The lunate is the most commonly dislocated carpal bone, and this code applies when the treating physician physically reduces the dislocation under appropriate anesthesia or sedation, typically with fluoroscopic confirmation. The code requires manipulation; if reduction is performed without it, a different code applies.

The 90-day global period means all routine follow-up, splinting adjustments, and office visits related to the dislocation are bundled through day 90. If an unrelated problem is addressed during that window, append modifier 24 to the E/M. If the dislocation fails closed treatment and open reduction (25695) becomes necessary as a planned staged procedure, use modifier 58. An unplanned return to the OR for a complication related to the original reduction bills with modifier 78.

Lunate dislocations frequently present alongside perilunate injuries and trans-scaphoid perilunate fracture-dislocations. When a concurrent scaphoid fracture is separately treated at the same encounter, NCCI bundling rules and distinct anatomical site documentation govern whether a second procedure code is separately reportable. Confirm with NCCI edits before appending modifier 59 or XS.

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 (5.58) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.44) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.58
Practice expense RVU	7.66
Malpractice RVU	1.2
Total RVU	14.44
Medicare national rate	$482.31
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	$482.31
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 25690 get rejected.

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

Missing post-reduction imaging documentation — payers require confirmation that manipulation was performed and successful
Upcoding to open treatment code 25695 when operative note does not describe an incision; closed vs. open distinction must be explicit
E/M billed same-day without modifier 25, when a separate and significant decision-making encounter preceded the reduction
Global period violation — follow-up visits billed without modifier 24 when the visit is related to the lunate dislocation within 90 days
ICD-10 mismatch — using a general wrist dislocation code instead of the lunate-specific code (S63.093x or equivalent laterality variant)

Frequently asked questions

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

01What's the difference between CPT 25690 and 25695?

25690 is closed treatment — no incision, manipulation only. 25695 is open treatment, requiring a surgical approach to reduce the lunate. If you made an incision, 25690 is the wrong code regardless of how straightforward the reduction appeared.

02Can I bill 25690 if fluoroscopy was used to guide the reduction?

Yes, and fluoroscopy confirmation is actually expected for documentation purposes. However, the fluoroscopy service itself is generally bundled into the procedure and should not be billed separately under most payer policies.

03If closed reduction fails and I proceed to open reduction at the same encounter, which code do I bill?

Bill only 25695 (open treatment). The failed closed attempt is not separately reportable when it occurs at the same session and the surgeon proceeds directly to open reduction. Do not bill both codes.

04How do I handle a concurrent scaphoid fracture treated at the same encounter?

Check NCCI edits for the specific code pair. If the scaphoid fracture treatment is a separately reportable service at a distinct anatomical site with its own procedure, append modifier 59 or XS and document the distinct nature of each procedure clearly in the operative note.

05Does the 90-day global include the cast changes and follow-up X-rays?

Routine cast changes and related follow-up office visits are bundled into the global. Diagnostic imaging ordered during global follow-up is separately reportable. If the patient develops an unrelated condition requiring an E/M during the global period, append modifier 24.

06Is modifier 50 appropriate for bilateral lunate dislocations?

Bilateral lunate dislocation is exceedingly rare but not impossible in high-energy trauma. If both wrists are reduced at the same session, modifier 50 (or LT/RT on separate lines per payer preference) applies. Document each wrist's dislocation and reduction independently.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the dislocation pattern (volar vs. dorsal lunate displacement), manipulation technique, anesthesia method, number of reduction attempts, and post-reduction fluoroscopy findings directly from dictation. It also flags median nerve status documentation before and after the procedure. This prevents the most common audit trigger: an operative note that confirms a dislocation existed but fails to substantiate that manipulation was actually performed and that anatomical reduction was achieved.

See how Mira captures CPT 25690 documentation