Fusion · Wrist

Wrist joint fusion using iliac crest or other autograft, including harvesting of the graft at the same operative session

Verified May 8, 2026 · 6 sources ↓

Medicare: $793.94
Total RVUs: 23.77
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeEmednyMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify joints fused — radiocarpal, ulnocarpal, or both — in the operative note
Name the graft donor site (iliac crest, distal radius, other) and document harvest technique
Document fixation hardware type and placement (dorsal plate, Kirschner wires, external fixator)
Record the surgical approach by name (dorsal longitudinal, etc.) — notes that say 'standard approach' flag on audit
Confirm preoperative diagnosis with supporting imaging findings (X-ray, MRI, CT) in the chart
Document failed conservative treatment or prior surgical history justifying fusion over arthroplasty

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 25810 covers complete wrist arthrodesis — radiocarpal and/or ulnocarpal fusion — performed with an autogenous bone graft harvested from the iliac crest or another donor site during the same operative session. The graft harvest is built into the code descriptor; billing a separate graft-harvest code alongside 25810 is a bundling error. This is a 90-day global procedure, meaning all routine postoperative management through day 90 is included in the surgical fee.

Distinguish 25810 from its near neighbors: 25800 is complete wrist fusion without any graft; 25805 uses a sliding graft rather than a free autograft; 25820 and 25825 cover limited (intercarpal or radiocarpal only) fusions. NCCI also bundles proximal row carpectomy (25210) with 25810 — the carpectomy is considered part of the fusion preparation when performed in the same session and cannot be separately reported.

Common indications include end-stage wrist arthritis from rheumatoid disease, post-traumatic arthritis, avascular necrosis, or failed wrist arthroplasty. Document the specific joints fused (radiocarpal, ulnocarpal, or both), the graft donor site, fixation method (plate, pin, or external fixator), and the approach. Payers differ on whether CT-based preoperative planning is separately reimbursable; verify by payer before billing imaging add-ons.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.65
Practice expense RVU	9.92
Malpractice RVU	2.2
Total RVU	23.77
Medicare national rate	$793.94
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	$793.94
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,107.15

Common denial reasons

The recurring reasons claims for CPT 25810 get rejected.

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

Separate billing of bone graft harvest code alongside 25810 — graft obtaining is included in the descriptor
25210 (proximal row carpectomy) billed same session without modifier — NCCI bundles it with 25810
Missing or inadequate documentation of specific joints fused — payers require joint-level specificity to validate code selection over 25800 or 25820
Lack of documented medical necessity — no imaging findings or failed conservative treatment in the record
Bilateral procedure billed as two units without modifier 50 (facility) or LT/RT on separate lines (ASC)

Frequently asked questions

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

01Is the bone graft harvest billed separately with 25810?

No. The code descriptor explicitly includes obtaining the autograft. Billing a separate graft-harvest code (e.g., 20900, 20902) alongside 25810 will be denied or recouped as an NCCI bundling violation.

02Can 25210 (proximal row carpectomy) be billed on the same day as 25810?

No. NCCI bundles 25210 with 25810. When carpectomy is performed as part of preparing the wrist for fusion in the same session, it is not separately reportable.

03What is the global period for 25810, and what does it cover?

25810 carries a 90-day global period. It covers the day-before preoperative visit, the surgery itself, and all routine postoperative care through day 90. Services unrelated to the wrist fusion in that window need modifier 24 (E/M) or 79 (unrelated procedure).

04How does 25810 differ from 25805 and 25800?

25800 is complete wrist fusion with no graft. 25805 uses a sliding (pedicled) graft rather than a free autograft. 25810 requires a free autograft harvested from the iliac crest or another distant donor site. Select the code that matches what was actually done — graft type determines the code.

05How should a bilateral wrist fusion be reported?

For facility/hospital outpatient claims, append modifier 50 to a single line. For ASC claims, bill two lines — one with modifier LT and one with modifier RT — each with one unit of service, per CMS NCCI billing policy.

06When is modifier 22 appropriate for 25810?

Use modifier 22 when the procedure required substantially more work than typical — for example, significant scarring from prior wrist surgery, hardware removal complicating the approach, or unusual anatomical complexity. Attach a cover letter documenting the added time and effort; expect a documentation request before the upward adjustment is paid.

07Can a co-surgeon bill 25810 with modifier 62?

Yes, if two surgeons of different specialties each perform a distinct portion of the procedure and the complexity genuinely requires co-surgeon involvement. Both surgeons append modifier 62 and each submits an operative note describing their specific work. Many payers require documentation explaining why a single surgeon was insufficient.

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 joints fused (radiocarpal, ulnocarpal, or combined), the autograft donor site, fixation construct, and surgical approach from the operative dictation. It flags if the note omits graft-harvest language — the single most common audit trigger for 25810 — and confirms that carpectomy language is noted as preparatory rather than as a separately billable step.

See how Mira captures CPT 25810 documentation