Open surgical treatment of a dislocated lunate bone in the wrist, involving incision, anatomic repositioning, and internal stabilization.

Verified May 8, 2026 · 6 sources ↓

Medicare: $600.88
Work RVU: 8.3
Global, days: 90
Region: Wrist

Drawn from CMSFastrvuNIHAAPCGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the dislocated bone specifically as the lunate — not generic 'wrist dislocation' — in both the preoperative diagnosis and operative note
Specify surgical approach by name (volar, dorsal, or combined) and describe direct visualization of the lunate
Document reduction maneuver and confirm anatomic repositioning, including intraoperative fluoroscopy or imaging findings
Record all fixation hardware placed (K-wires, screws, pins) with size and configuration
Document any concomitant ligament repairs or additional carpal procedures performed and their independent indications
Include preoperative imaging (X-ray, CT, or MRI) confirming lunate dislocation and characterizing associated injuries
Note neurovascular status of the hand pre- and post-reduction, particularly median nerve function given volar carpal tunnel proximity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25695 covers open reduction of a lunate dislocation — one of the most destabilizing carpal injuries, typically caused by high-energy trauma such as a fall on an outstretched hand with significant axial load. The surgeon makes a volar, dorsal, or combined wrist incision to directly visualize the displaced lunate, reduce it to its anatomic position within the proximal carpal row, and secure it with pins, K-wires, or screws. Ligamentous repair is frequently performed at the same sitting; separately reportable codes may apply depending on what additional structures are addressed.

This carries a 90-day global period. All routine post-op visits, cast changes, and K-wire removals performed by the operating surgeon through day 90 are bundled. If a separately identifiable condition is addressed during that window — or a staged reconstructive procedure is planned — attach the appropriate modifier. The closed-reduction counterpart is 25690; the open code (25695) is appropriate only when direct surgical access and manipulation of the lunate are performed.

Lunate dislocations are frequently associated with perilunate injuries, scaphoid fractures, and intercarpal ligament disruption. Document each injury and each procedure performed to support medical necessity and to capture any separately billable concomitant work. Operative notes that address only 'wrist dislocation' without specifying the lunate as the primary pathology will draw scrutiny on audit.

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 (8.3) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.99) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.3
Practice expense RVU	7.93
Malpractice RVU	1.76
Total RVU	17.99
Medicare national rate	$600.88
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	$600.88
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25695 get rejected.

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

Operative note describes 'wrist dislocation' without naming the lunate, failing to justify 25695 over less specific codes
Concomitant ligament repair billed separately without documentation establishing a distinct, independently indicated procedure
Missing preoperative imaging in the record to confirm dislocation diagnosis and support medical necessity
Modifier absent when 25695 is billed during the global period of a prior related wrist procedure
Place-of-service mismatch between the claim and the actual facility where the procedure was performed

Frequently asked questions

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

01What is the difference between CPT 25690 and 25695?

25690 is closed treatment of lunate dislocation with manipulation. 25695 requires open surgical access — an incision, direct visualization, and manual or instrument-assisted reduction of the lunate. If you opened the wrist, bill 25695.

02Can I separately bill a ligament repair performed at the same time as the open lunate reduction?

Potentially, if the ligament repair is a distinct, independently indicated procedure documented as such. Attach modifier 59 or XS and ensure the operative note supports separate medical necessity. Payers vary — some bundle volar capsule repair with the open reduction.

03What global period applies to 25695?

90-day global. K-wire removal, cast changes, and routine post-op visits by the operating surgeon within that window are bundled. Use modifier 79 for a truly unrelated procedure in the global period, or modifier 78 for an unplanned return to the OR for a related complication.

04Is 25695 typically performed in a hospital or ASC?

Both settings are appropriate. CMS 2026 HOPD payment and ASC payment differ significantly — see the Site of Service comparison on this page. Most acute perilunate/lunate dislocations present as emergencies and are performed in a hospital OR.

05What ICD-10 diagnosis codes align with 25695?

S63.094 (dislocation of lunate, unspecified wrist) is the primary match, with laterality-specific variants S63.091 (right) and S63.092 (left). Perilunate dislocation codes may also apply depending on the injury pattern — confirm the precise carpal anatomy documented in imaging.

06Should modifier 22 be used when the reduction is unusually complex?

Yes, if the procedure required substantially increased time or technical difficulty — for example, a chronic or neglected dislocation with significant scarring, or a combined perilunate-lunate injury requiring extended dissection. Attach a written justification to the claim; payers require documentation of why complexity exceeded typical.

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 bone involved (lunate), surgical approach (volar/dorsal/combined), reduction method, fixation hardware used, intraoperative fluoroscopy findings, and any associated ligament repairs with their independent indications — all from dictation. This prevents the most common audit flag for 25695: an operative note that says 'wrist dislocation' without documenting lunate-specific pathology and direct open reduction.

See how Mira captures CPT 25695 documentation