Fusion · Wrist

Limited wrist arthrodesis (fusion) performed without bone graft, addressing one or more specific intercarpal or radiocarpal joints while preserving motion at uninvolved joints.

Verified May 8, 2026 · 5 sources ↓

Medicare: $615.24
Total RVUs: 18.42
Global, days: 90
Region: Wrist

Drawn from CMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which joints are fused by name (e.g., scaphotrapeziotrapezoid, capitolunate, radiolunate) — notes that only say 'limited wrist fusion' are audit targets
Confirm no bone graft was harvested or used; if graft was used, 25825 applies instead
Document the indication: radiographic evidence of arthritis, instability, or collapse pattern (SLAC/SNAC staging is ideal)
Describe fixation hardware used (K-wires, headless screws, plate), including size and number, even if not separately billable
Record pre- and intraoperative wrist range of motion or instability findings to support medical necessity
Operative note must name the surgical approach — 'dorsal approach' is acceptable; 'standard approach' is not

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 24 Unrelated E/M during global 25 Significant separate E/M 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side 62 Co-surgeons AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25820 describes a limited wrist arthrodesis — surgical fusion of selected carpal or radiocarpal joints — performed without bone graft. Unlike a total wrist fusion (25800), this procedure targets only the diseased or unstable joints, leaving adjacent joints mobile. Common indications include scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), and isolated radiocarpal or midcarpal arthritis.

The 90-day global period covers the surgery, the day-before visit, and all routine postoperative management including cast changes, suture removal, and standard wound care through day 90. Anything outside routine post-op care — a new injury, unrelated E/M, or a distinct complication procedure — requires modifier 24, 25, 78, or 79 depending on the circumstance. Billing an E/M in that window without modifier 25 on the same day as a separate minor service is an NCCI exposure point.

Site of service matters significantly here: HOPD and ASC payments differ substantially (see the Site of Service comparison). Because no bone graft is harvested, donor-site coding does not apply — billing a separate graft harvest code alongside 25820 would be an unbundling error. If internal fixation (K-wires, screws, or plates) is used to stabilize the fusion construct, those implants are part of the surgical service and are not separately reportable under Medicare. Document implant details in the operative note regardless, as payers may request itemization.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.45
Practice expense RVU	9.52
Malpractice RVU	1.45
Total RVU	18.42
Medicare national rate	$615.24
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	$615.24
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,064.57

Common denial reasons

The recurring reasons claims for CPT 25820 get rejected.

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

Bone graft code billed alongside 25820 when graft was not used, or 25820 used when graft was used (should be 25825)
E/M billed during the 90-day global without modifier 24 or 25, triggering global period bundling denial
Medical necessity denial when documentation fails to show failed conservative treatment or adequate radiographic staging
Unlisted implant or hardware code billed separately, triggering NCCI bundling denial
Bilateral modifier 50 appended without documentation confirming both wrists were fused in the same operative session

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 25820 and 25825?

25820 is limited wrist arthrodesis without bone graft. 25825 is the same procedure with bone graft. If autograft, allograft, or bone substitute is used to pack the fusion site, bill 25825. Billing 25820 when a graft was used will not hold up to audit.

02Can I bill 25820 and 25800 together if I fused all wrist joints?

No. If you fused the entire wrist, bill 25800 (total wrist arthrodesis) alone. Billing 25820 alongside 25800 for the same wrist is unbundling — NCCI treats total fusion as inclusive of limited fusion work.

03Does the 90-day global period prevent billing for postoperative X-rays?

Radiology codes are not part of the surgical global package. Post-op imaging is separately billable. The global covers physician work only — E/M, dressing changes, suture removal, and routine wound care.

04Can modifier 22 be used if the fusion was technically demanding due to severe collapse or prior hardware?

Yes, if the operative note specifically documents the increased intraoperative time, complexity, or unusual difficulty — prior hardware removal, severe deformity, or difficult exposure. Generic statements about complexity won't survive a payer audit. Quantify the extra time and describe what made it difficult.

05Is fluoroscopy billed separately during wrist arthrodesis?

Not for Medicare. Intraoperative fluoroscopy used during a musculoskeletal surgical procedure is integral to the surgery and is not separately reportable under NCCI policy. Some commercial payers follow different rules — check your contract.

06How does site of service affect reimbursement for 25820?

HOPD payment is higher than ASC payment for this code. For elective cases, shifting to ASC reduces the facility payment — see the Site of Service comparison table on this page. Surgeon professional fee is the same regardless of setting.

07Can a PA or NP bill for post-op visits under the 90-day global?

Post-op visits within the global are included in the surgeon's global package — they cannot be separately billed by the operating surgeon's practice. If a different group's PA or NP sees the patient for a truly unrelated issue, that's a different scenario and requires modifier 24 on a separate claim.

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 specific joints fused (e.g., capitolunate, scaphotrapeziotrapezoid), confirmation that no bone graft was used, fixation method and hardware, and the collapse or arthritis pattern driving the indication. That level of specificity prevents the two most common denials: wrong-code selection between 25820 and 25825, and medical necessity rejections from vague operative notes.

See how Mira captures CPT 25820 documentation