Fusion · Wrist

Complete wrist fusion without bone graft, spanning radiocarpal, intercarpal, and/or carpometacarpal joints — internal fixation only, no graft harvest.

Verified May 8, 2026 · 6 sources ↓

Medicare: $673.36
Total RVUs: 20.16
Global, days: 90
Region: Wrist

Drawn from AAPCNIHGenhealthCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm fusion is complete — radius fused to carpal bones — not limited to intercarpal joints only
Explicitly state that no bone graft was used (no harvest site, no sliding graft, no allograft)
Name all joints fused: radiocarpal, intercarpal, carpometacarpal — as applicable
Describe internal fixation method (plate, K-wires, screws) and hardware specifics
Document laterality (left, right, or bilateral) in both the operative note and the claim
Include a clear diagnosis with supporting imaging and conservative treatment history establishing medical necessity for complete arthrodesis

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25800 covers complete wrist arthrodesis performed without a bone graft. 'Complete' means the radius is fused to the carpal bones — not just a partial carpal fusion. That distinction matters: if only carpal bones are fused to each other (sparing the radiocarpal joint), you're in limited arthrodesis territory (25820–25825). Use 25800 only when the fusion spans the full wrist construct and no graft — sliding, iliac, or otherwise — is harvested or applied.

The no-graft distinction separates 25800 from 25805 (sliding graft) and 25810 (iliac or other autograft). If the surgeon harvests bone from the iliac crest or another donor site, 25810 is correct. If a sliding cortical graft is fashioned from adjacent bone without a separate harvest, use 25805. Document the graft decision explicitly — payers audit this because the three codes carry different reimbursement levels.

This code carries a 90-day global period. All routine follow-up — cast changes, staple removal, wound checks — is bundled through day 90. Any unrelated E/M or procedure during that window requires modifier 24 or 79, respectively. Hardware removal after the global closes is reported separately. Confirm bilateral cases with LT/RT modifiers; if both wrists are fused in the same session, modifier 50 applies with payer-specific bilateral payment rules.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.82
Practice expense RVU	8.46
Malpractice RVU	1.88
Total RVU	20.16
Medicare national rate	$673.36
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	$673.36
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,187.76

Common denial reasons

The recurring reasons claims for CPT 25800 get rejected.

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

Code mismatch: 25820/25825 (limited) billed when radiocarpal fusion was performed — or 25800 billed for an intercarpal-only case
Bone graft discrepancy: operative note describes graft material but 25800 (no graft) is submitted — should be 25805 or 25810
Missing or inadequate medical necessity documentation — payers require failed conservative care or imaging evidence of end-stage wrist pathology
Modifier 24 or 79 absent when an unrelated service is billed during the 90-day global period
Laterality not specified on claim — LT/RT omitted, triggering edit or rejection

Frequently asked questions

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

01What makes a wrist arthrodesis 'complete' versus 'limited'?

Complete means the radius is fused to the carpal bones — the radiocarpal joint is involved. Limited (25820–25825) fuses only carpal bones to each other, leaving the radiocarpal joint intact. Radioscapholunate fusion without radius involvement is limited. If the surgeon bridges radius to carpus, it's complete.

02Can I bill 25800 if the surgeon used local bone debris or reamings for void filling?

Using local bone reamings or morselized debris from the surgical site is generally not considered a 'bone graft' in the 25805/25810 sense. 25800 is appropriate. If a separate iliac or allograft source is used, move to 25810. Document the source explicitly — payers will ask.

03What's the global period, and what's bundled into it?

25800 carries a 90-day global. Routine post-op visits, cast changes, wound checks, and staple removal through day 90 are all bundled. Bill unrelated E/M visits with modifier 24 and unrelated procedures with modifier 79. Hardware removal within the global for a complication is modifier 78.

04How do I bill if both wrists are fused in the same operative session?

Use modifier 50 for bilateral same-session procedures, or submit two line items with LT and RT per payer preference. Medicare and most commercial payers pay the bilateral rate at 150% of the single-procedure allowable, but verify your payer's bilateral policy — some apply a flat reduction.

05Is 25800 ever reported with 25820 on the same date?

Not for the same wrist — a wrist is either completely or limitedly fused, not both. If different wrists are operated on in the same session, LT/RT modifiers separate the claims. Billing both complete and limited fusion codes for the same wrist on the same date will trigger an NCCI edit.

06What ICD-10 diagnoses best support medical necessity for 25800?

Common supporting diagnoses include post-traumatic wrist arthritis (M12.539), severe rheumatoid arthritis of the wrist (M06.039), and wrist instability with joint destruction. Payers expect imaging documentation and a record of failed conservative management. Diagnosis alone without that history is a frequent medical necessity denial trigger.

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 fusion extent (complete vs. limited, joints involved), explicit absence of bone graft, internal fixation construct, and laterality directly from surgeon dictation. That prevents the most common 25800 audit flag: operative notes that describe the hardware without clearly documenting graft status, which reviewers interpret as a missing element and downcode to an unlisted or query-hold status.

See how Mira captures CPT 25800 documentation